Watering eye (epiphora or tearing) can be an extremely annoying problem. Constant overflow of the tears onto the face can cause breakdown of the skin resulting in irritation and even rashes of the eyelid skin. In addition, tearing can also cause distortion of the vision sometimes making driving difficult and even dangerous. Tearing can develop at any age. It is, however, more common among babies aged less than 12 months, and adults over the age of 60 years. The condition may present symptoms in just one or both eyes.
There are many causes of epiphora, however for the purposes of this blog we will focus on the most common etiology typically found in patients over the age of 60.
What are the causes of epiphora (watering eye)?
There are two main causes of epiphora – blocked tear ducts or excessive production of tears. Over-production of tears – irritated eyes may produce more tears than normal as the body tries to rinse the irritant away. The following irritants can cause the over-production of tears:
Some chemicals, such as fumes, and even onions
An injury to the eye, such as a scratch or a bit of grit (tiny pebble or piece of dirt)
Eyelid malposition such as entropion or ectropion causing irritation to the ocular surface
Lashes growing the wrong direction can abrade the surface of the eye
A poor tear film in some patients may interfere with the even spread of tears across the eye, leaving dry patches which trigger a reflex tearing.
Blocked tear ducts – The most common cause of watering eyes among adults is a blocked ducts, or ducts that are too narrow. There are many causes for a blocked tear duct including previous nose surgery or trauma, chronic sinusitis, polyps, sinus tumors, radiation, stones within the drainage system, infections, and even bony remodeling of the craniofacial skeleton as we age, causing a narrowing of the bony space housing the tear duct.
If a patient’s tear ducts are narrowed or blocked their tears will not be able to drain away and will build up in the tear sac. Stagnant tears in the tear sac increase the risk of infection in that area and the eye will produce a sticky liquid, further exacerbating the problem. Infection can also lead to inflammation on the side of the nose, next to the eye.
How is the cause of the watery eye diagnosed?
Diagnosing the cause of a teary eye is not always straightforward. A probe might be inserted into the narrow drainage channels on the inside of the eye (canaliculi) to see whether they are blocked. A cannula is sometimes inserted in to the duct to see if the fluid follows the correct pathway and exits inside the patient’s nose. Neither of these techniques will resolve the problem and are used strictly for diagnostic purposes.
What is the treatment for a blocked tear duct?
Blocked tear ducts – surgery which creates a new channel from the tear sac to the inside of the nose may be necessary. This allows the tears to bypass the blocked part of the tear duct. This surgical procedure is called DCR (dacryocystorhinostomy).
What if I choose not to have it treated?
Dacryocystitis – Acute dacryocystitis is an infection of the tear drainage sac. It is often manifested by the sudden onset of pain, erythema, and edema overlying the lacrimal sac region. If the infection is not treated promptly, these infections can spread causing possible orbital cellulitis, abscess formation and in rare cases, blindness, cavernous sinus thrombosis and even death.
Although dacryocystitis can often be temporarily treated with antibiotics, it invariably will recur. The gold standard treatment is to proceed with DCR surgery. Often times it is best to perform DCR surgery prior to progression to dacryocystitis so that surgery can be performed under scheduled, optimal conditions (patient has discontinued aspirin, has someone at home to care for them, etc) rather than under urgent or even emergent conditions.