Dr. Rizwana Khan

Watery Eye

Epiphora, or watery eye, is due to overflow of tears. It may be caused by a variety of ocular disorders, which can result in acute or chronic epiphora.

Acute epiphora is caused by irritative diseases of the ocular surface and resolves with the treatment of the disorder.

Chronic epiphora, on the other hand, is usually due to long-standing disorders and can cause epiphora with excessive tears sometimes streaming down the patient’s face.

The main causes of epiphora are hypersecretion (overproduction) of tears and outflow failure.

Causes of hypersecretion (overproduction of tears) include:

  • Eyelid diseases like blepharitis, mebomian cysts and molluscum contagiosum.
  • Eyelid malposition like ectropion, entropion and lid retraction.
  • Eyelid weakness secondary to facial-nerve weakness.
  • Other causes include trichiasis (misdirected lashes), corneal foreign bodies, conjunctival concretions, corneal abrasion or infections, ocular surface diseases and dry eye syndromes.

Causes of outflow failure  (obstruction in the tear drainage system) Include:

  • Congenital punctual or canalicular atresia (upper tear duct blockage)
  • Acquired punctual and canalicular malposition/ blockage, trauma, infections (herpes zoster, simplex, adenovirus, actinomyces), pharmacological agents.
  • Nasolacrimal duct obstruction (blockage of the lower/nasal part of ear duct opening) secondary to congenital causes, trauma, neoplasm, nasal polyps, allergic rhinitis, chronic atrophic, inflammatory or destructive conditions in the nose and nasal surgery. 

Initial management is directed towards treating the identifiable causes. History should help identify the problem, establish the severity and the possible
etiology.

The conditions leading to hypersecretion (overproduction) of tears can be treated and eyelid malpositions can be corrected surgically.

A common cause of hypersecretion is dry eye, which also causes symptoms of grittiness, foreign body sensation and burning, tired and itchy eyes.

This can be diagnosed simply by examining the tear film break-up time and the corneal surface.

Diagnosis can be aided by measurement of tear production and treatment is lubricant drops and, in some cases, punctal plugs.

If epiphora is due to eyelid disorder or malposition it requires surgical correction.

The treatment of nasolacrimal obstruction varies depending on the severity of the epiphora; patient may decide not to have any treatment.

Treatment options include syringing and probing in children, intubation of the nasolacrimal system or DCR (surgery involving formation of a new tear duct) which may be carried out through external or endonasal (through the nose) approach.

DCR involves fistulisation of the lacrimal sac into the nasal cavity and by passing nasolacrimal obstruction.

External DCR has 95 per cent or more success rate. Endonasal DCR on the other hand tries to mimic external DCR but without the disadvantages of a scar and orbicularis and medial canthal tendon disruption.

The success rate with the current technique is as high as 95 per cent but the disadvantages are the limitations due to nasal anatomical variation and pathology.

“On Tuesday I had the little lacrimal tube removed by Dr Khan following my recent DCR. I just want to tell you how successful it was & how thankful I am to you. I have been miserable for years suffering a watery eye. It has spoiled many occasions. I am elated with the results & almost afraid to think that it will be permanent. I haven’t had to wipe my eye once since Tuesday! Out of habit I keep wanting to and have to stop myself.  I will save a fortune on tissues! Even today, Mid Summer’s Day!!!, wet & windy, the only water on my face was the rain! Thank you so much & wishing you continued success in the wonderful work you do.” – Ms L McG, Dublin

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