Watery Eyes

1 Watery Eyes Summary

Watery eyes are the excessive production of tears in the eyes and overflowing of tear down the cheek. Tear is produced by the tear gland present on the outer part of the eyelid. Tears produced by the gland run across the eyes and gets drained through the small opening present at the corner of the eye.

The short channel that drains tear is called as canaliculus, through which it runs into the nose. A blockage in any of the part of the duct may lead to watery eyes. Blockage of tear duct increases the risk of infection in tear sac. This infection may sometimes spread to the surrounding tissue.

Watery eyes, also called as epiphora, may occur at any age but is more common among infants under one year. It is also seen in people over 60 years of age. Watering may happen in one of the eyes or in both the eyes.

Some of the symptoms that are associated with watering of eyes include eye pain, eye inflammation, infection of the eye, runny nose, changes in vision, allergies, sneezing, swelling in the eye, and redness in the eye. In most of the cases, watery eyes can be successfully treated. In severe conditions, it may lead to considerable discomfort during activities like driving.

Watering of eyes may be caused by blockage of tear ducts or by excessive production of tears. Underdeveloped tear ducts result in watery eyes in infants, while in adults inflammation may narrow the tear ducts causing overflowing of tear onto the face.

The buildup of a tear in the tear duct due to blockage increases the chance of infection. Swelling and scarring may also lead to narrowing of canaliculi. Irritation of eyes causes overproduction of tear that helps in washing away the irritant. Some common irritants that lead to watering of eyes are chemicals, injury, inward growth of eyelashes, and turning outwards of the lower eyelid.

Examination of eye enables the diagnosis of the cause including injury, lesion, infection, and ectropion. If the cause is not determined by normal examination, it may be referred to an ophthalmologist.

Blockage of tear duct is detected by using a probe that is inserted into the drainage channels. To identify the location of blockage a dye may be injected into the duct. The canaliculi are then visualized using an x-ray. Accumulation of dye in the blockage region can be seen in the x-ray.

Treatment of watery eyes depends on the severity and cause of the condition. When watering is mild, monitoring may be enough than starting any treatment. Infective conjunctivitis may be treated with antibiotics.

Inward growth of eyelashes, that cause watery eyes, is removed to alleviate watering. Surgery provides bypass route for the tear to pass to the nose. Partial blockage of the duct may be removed by the probe.

In children, the watering of eyes may resolve on its own. Eyes are cleaned by using a cotton piece dipped in sterile water. Surgery may be done externally or internally. An external procedure is done through the skin, while internal procedure uses an endoscope.

2 Causes

Watery eyes are caused by multiple factors. Tear is produced by lacrimal glands and runs across the eyes before drained into the duct present at the corner of the eyes. The duct then drains the tear into the nose.

The two most common causes of the condition are:

Blockage of tear ducts – either partial or complete, blockage prevents the complete draining of tear into the nasolacrimal duct. The excess tear then overflows onto the face, causing watery eyes.

Overproduction of tear – many factors causes excessive production of tear by the glands. The excess tear is then drained onto the face, rather than the duct.

Some common causes of watery eyes are:

  • Allergies – allergy is an exaggerated response of the immune system to a specific irritant. The severity of response varies with the person and the irritant. Watering or eyes is a common symptom of many types of allergies.
  • Inflammation of eyelid – inflammation of eyelid or blepharitis may involve part of the eyelid. It irritates the eyes and causes redness, itching, and watering of eyes.
  • Common cold – viral infection of nose and throat result in common cold, for which watering of eyes is a common symptom.
  • Corneal abrasion – a scratch on the cornea caused by dust, dirt or any other foreign particle may lead to pain, redness, and tearing.
  • Corneal sore – an open sore in the cornea may cause serious symptoms like loss of vision and blindness. It may also lead to watering of eyes.
  • Dry eyes – dry eyes is a cause of irritation of eyes, leading to watering.
  • Entropion – entropion or inwardly turned eyelids cause much irritation and discomfort to the eyes. Irritation causes excess production of tear by the gland, leading to tearing.
  • Ectropion -- In elderly people, the eyelids may sag, causing accumulation of tear in the eyeball which later flows out.
  • Foreign object in the eye – presence of a foreign object in the eye this is a temporary cause of tearing.
  • Hay fever – hay fever or allergic rhinitis is characterized by symptoms resembling cold, including sneezing, watery eyes, and itching of the eyes.
  • Ingrowth of eyelash – ingrowth of eyelash or trichiasis is another cause of watering from the eyes.
  • Keratitis – inflammation of cornea is known as keratitis. Infection of the cornea by different agents including bacteria, fungi, and parasites may result in keratitis. Minor injury to the cornea may also result in inflammation and is one of the noninfectious keratitis.
  • Conjunctivitis – infection or inflammation of the conjunctiva is referred to as conjunctivitis. It causes reddishness and watering of eyes.
  • Sty – sty is a painful lump that forms on the eyelid. It causes considerable pain, discomfort, and watering from the affected eye.
  • Trachoma – trachoma is a contagious bacterial infection of the eye. It causes itching and irritation of the eye. Irritation caused by the infection leads to excessive production of tear from the gland.

Some other less common causes of the tearing include Bell’s palsy, burns, chronic sinusitis, inflammatory diseases, radiation therapy, rheumatoid arthritis, sarcoidosis, thyroid disorders, surgery of eye and nose, and tumors of eyes. Certain medications like epinephrine, eye drops, and drugs used in chemotherapy are known to cause excessive tearing.

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3 Diagnosis and Treatment

Most cases of watering may not require a detailed evaluation by the doctor. Review of symptoms and medical history, followed by physical examination may help in identifying the probable cause of watering in the eyes.

Information on other accompanying symptoms like eye irritation, reddishness, pain, and itching are also helpful in identifying the causes. Recent events like injuries, burns, radiation therapy and surgical procedures may also be of value in the diagnosis of the condition.

Information on current medications and other medical conditions also should be reported to the doctor for confirming the diagnosis. During the physical examination, the doctor may examine eyelids and the area at the inner corner of the eyes.

Slit lamp examination to observe the eye under high magnification helps to visualize the inner part. The cause is based on medical history and physical examination. For further tests, the person may be referred to an ophthalmologist.

During an eye examination, the ophthalmologist may insert a probe into the eyelid or canaliculi to detect blockages, if any. To check whether the fluid drainage into the nose is normal, fluid may be gently flushed through the duct.

In some rare cases, imaging studies and procedures are recommended. An imaging study of tear duct and CT scan of nasal cavities, and endoscopy of the inside of the nose are suggested depending on the probable cause of the condition.

To identify the location of the blockage, a dye is inserted into the duct. The duct is then visualized using x-ray, in which the buildup of dye shows the location of the blockage.

Treatment varies with the underlying cause of tearing. Mild watering of eyes may not require any treatment. Removing the cause of irritation from the eye helps to alleviate watering.

Inwardly growing of eyelids, or entropion, are removed to prevent the watering of eyes. Conjunctivitis is treated with eye drops, while foreign pieces stuck in the eye are removed to reduce watering. Infective conjunctivitis is treated with antibiotics.

Another common treatment method is the removal of drainage problems.

  • Ectropion or outwardly turned eyelids are surgically repaired to reduce tearing.
  • Infants with excessive watering of eyes may not require any specific treatment and will resolve on its own.
  • In adults blockage of tear duct is also removed by surgical procedures. Dacrocystorhinostomy (DCR) is a surgical procedure in which a new passage is made between tear sac and nose. This is usually used to bypass blockages below the tear sac. It helps to retain the normal drainage of a tear in the eyes. DCR is also suggested when the risk of sac infection is high. It can prevent recurrent swelling and pain in the eyes. DRC can be done externally or internally. External repair is done through the skin, while in internal method surgical repair is done endoscopically through nostrils.
  • Incomplete blockage of canaliculi is treated by widening the duct using a probe. The probe helps to open up the narrow canal, thus ensuring easy drainage of the fluid in the eyes.
  • A complete blockage may need surgical removal of the blockage. This will help in draining the tear into the nose.
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