Information - Epiphora or Watery Eye

Tears are a mixture of water, salt, protein and mucus. They are constantly produced to keep the eyes moist and healthy. Tears also help to wash away dirt from the surface of the eyes. Some people suffer from too many tears, and their eyes are constantly watery which causes discomfort.

 

Epiphora:  An abnormal overflow of tears from the eyes. Acute episodes of epiphora usually result from an irritant to the eye. Chronic epiphora is usually more complex, and the condition may require surgery.

Tear Production and Drainage: Tears flow into the eyes through tiny tubes from the lacrimal glands. Tears drain way from each eye through two tiny openings called puncta, one on each of the upper and lower lids. From the puncta, the tears drain into small tubes called lacrimal ducts or canaliculi, located in the inner corner of the eyelids. These lead to the lacrimal sac, a small pouch just beneath the inner corner of each eye, between the eye and the nose. This is where the tears gather and then drain into the nasolacrimal duct, the tube that leads to the inside of the nose. From there, the tears empty into the nostrils or to the back of the throat.

Causes of Epiphora

The two most common causes of epiphora are:

·        A blockage somewhere in the system of the eye.

·        An over-production of tears.

A blockage can occur because:

·        The system is not fully developed. This is a common cause of epiphora in children. Babies are often born with blocked lacrimal ducts, or blocked or underdeveloped nasolacrimal ducts.

·        Scars from old injuries or infections are blocking the lacrimal duct drainage system.

·        Eyelid deformities are preventing drainage of tears.

·        A punctum is blocked due to old age, infection, or trauma.

·        The mucous membranes of the ducts have some degree of age-related atrophy.

 

Over-production of tears can be caused by:

·        Dry eye syndrome.

·        Irritating matter in the eye.

·        Smog, smoke or pollen in the air.

·        Cold wind in the face.

·        Lack of sleep.

·        Looking at bright lights.

·        Eyestrain.

·        Irritation to the eye from ingrown eyelashes or an injury to the eye.

·        Build-up of debris.

Symptoms of Epiphora

·        Tears on the cheeks and in the eyelashes, which may become matted.

·        Mucus or pus-like discharge from the lacrimal duct openings (puncta).

·        Red, irritated eyelids.

·        Blurred vision because of the amount of tears in the eyes.

·        A tender lump and redness on the inner corner of the eyelid; this may indicate infection of the lacrimal sac where the tears gather but deteriorate because they don’t drain properly.

Diagnosis and Non-Surgical Treatment

Your optometrist will ask about your symptoms and examine your eyes to check for irritation, infection, injury and other conditions. A decision about treatment should be made only after discussion with your optometrist.

Make a decision only when you are satisfied with the information you have received and believe you have been well informed. Also discuss with your optometrist the treatment to be done, the reasons why, and the likely outcome expected.

Non-Surgical Treatment: The cause of acute epiphora is usually diagnosed quickly and treated without surgery. If epiphora is due to foreign matter in the eye, the cause can usually be easily removed. If environmental factors are causing epiphora, it can be treated with one or more medications avoiding the cause. Allergies may be treated with antihistamine tablets or eye drops. If bacterial infection is the cause, antibiotics are usually and effective treatment. Your optometrist may also suggest that you apply warm compresses to your eyes to help relieve minor eye infections that cause epiphora.

However, if the infection is caused by a blockage in the tear duct drainage system, antibiotics and warm compresses will not remove the blockage.

These treatments only help to treat the symptoms, and surgery may be recommended to clear the blockage. Ingrown eyelashes that rub on the cornea and cause epiphora need to be removed.

When epiphora is caused by dry eye syndrome, a variety of treatments are available to help correct the problem.

Diagnosis and Surgical Treatment

If epiphora is caused by a blockage somewhere in the lacrimal drainage system, surgery may be recommended. Location of the site of the blockage is necessary so the optometrist knows how to treat it.

·        Dye Test

A few drops of a special dye are put into the watery eye. If the dye drains down through the lacrimal drainage system and is seen to collect at the base of the nose, the drainage system is probably clear, and no further tests should be necessary. If the dye overflows onto the cheek, the lacrimal drainage system may be blocked, and further tests are needed.

 

 

·        Syringing and Probing

To locate the blockage, a narrow probe is inserted into a lacrimal duct leading to the lacrimal sac. If the probe enters the sac without resistance, the blockage is probably further down the drainage system. By observing exactly where the probe meets with resistance, the optometrist can determine the most likely site of the blockage. Weak salt water is then syringed into the lacrimal duct, helping to clear and clean. If your blockage is fairly minor, syringing and probing may clear the site, restoring normal tear drainage.

 

 

·        X-ray Examination

The eye doctor may need to perform a special X-ray examination called macro dacryocystography if the blockage is not clearly defined by the probing test by injecting dye into the punctum.

·        DCR Procedure

If the blockage is located in the nasolacrimal duct and cannot be cleared by probing, a DCR bypasses the blockage by creating a new passage between the lacrimal sac and the inside of the nose. To do this, bone is removed between the lacrimal sac and nasal cavity, and the lacrimal sac is then joined to the lining of the nose to create a new outlet for tears. To keep the new drainage duct open, a tiny silicone tube may be inserted during the procedure and left in place during healing. It is usually removed 6 weeks to 6 months after the operation in another minor surgical procedure.

·        Lester-Jones Tube

Sometimes a blockage in a lacrimal duct can’t be cleared. Your optometrist may suggest and operation to implant an artificial lacrimal duct, called a Lester-Jones tube, so tears can drain properly and is intended to be implanted permanently.

 

Specific Complications of Surgery to Treat Epiphora

·        Bleeding from the nose: Can be controlled by the use of medicated swabs.

·        Infection: Your surgeon may prescribe antibiotics after your surgery, or ask you to spray antibiotic drops into your nose.

·        If a tube has been inserted into the lacrimal drainage system, sometimes the tube may move, fall out, scratch the cornea, or become blocked after surgery. This may require further surgery.

·        Rarely, cerebrospinal fluid (the protective water surrounding the brain and spinal cord) may leak when an opening is made in the bone of the upper nose to allow the tears to drain freely. Surgery and treatment with antibiotics may be necessary to repair the leak and prevent infection.