Watery Eyes in Adults (Epiphora)
David Kinshuck
An explanation of the common causes of watery eyes, and related problems.
Normal tears
Tears are made in a gland under the skin above the eye. They flow over the front surface of the eye, and drain into tiny tear ducts in the eyelids, near the nose (under the skin).
The tears then flow into a tear 'sac', and from there they pass through a wide channel, the 'naso-lacrimal duct' into the inside of the nose. See Animation.
healthy tear flow over the eye into the nose:
Symptoms
- constant watering of the eyes, indoor and outdoors
- gritty feeling followed by watering
- watering of eyes, mostly when outside
- watery eyes made worse by cold wind or bright light
- sore eyelids
Main causes of watery eyes (epiphora)
The causes often occur in combination
- too many tears
- blepharitis.. causing poorly spreading tears
- eye lid laxity ectropian/entropian
- naso-lacrimal duct blockage
- partial blockage
Too many tears
There are some conditions that can cause your eye make too many tears. Many people with watery eyes have a combination of too many tears and blocked tear duct. Conditions that 'cause' watery eyes include
- in-growing eye lashes
- dry eyes this makes the eyes sore and causing reflex watering
- Other causes of irritation
Irritation...in-growing lashes and dry eyes and other causes
In-growing eyelashes (trichiasis)
In-growing eyelashes or anything that irritates the eye may cause a watery eye.. In-growing lashes need to be removed, although they may grow in again.
If there is only one lash growing in, in an eye clinic, the lash is epilated (removed) once, and if it grows in again then electrolysis may help.
Dry eyes
Surprisingly, if your eyes are 'dry' you may notice watery eyes: your eyes become sore and this makes your eye make more tears. But these tears may not spread properly, and dry patches develop on the surface of the eyes (as below).
Using artificial tears can help make the eye feel a lot more comfortable; the artificial tears may spread more evenly, and you can buy them from the chemist. See 'dry eye'. Gel type of artificial tears are generally best to try first.
Conjunctivochalasis....a fold on conjuctiva (grey) prevents tears spreading (green) making the eyes water and irritable enlarge
Conjunctivochalasis
This is a fold of conjucntiva just above the bottom lid. OS19. If the eye is very watery this can be treated with lubrication drops of occasionally surgery.
Other causes of irritation
- Grit or sand under the eyelid cause too many tears. Eyes may water if anything irritates them: a small scratch, a piece of grit under the upper eyelid.
- Eye drops for glaucoma are common causes of irritation, especailly if they have preservative.
- Thyroid eye disease is an unusual cause
- or an allergy
Blepharitis....causing poorly spreading tears
| treatment of blepharitis |
|---|
Blepharitis is the medical term for inflamed eyelids. The inflammation is like eczema of the skin, with red, scaly eyelids. You may notice watery, tired, or gritty eyes, which may be uncomfortable in sunlight or a smoky atmosphere. They may be slightly red, and feel as though there is something in them.
The eyelids have tiny glands in them, especially the lower lids. These glands make substances that mix with tears, and help the tears to spread across the eye. If these glands are blocked they will not release these chemicals (wetting agents).
The tears then become too thin and do not spread evenly across the eye dry patches may develop on the surface of the eye. These dry patches make the eye feel sore and then your eyes may start to water. This is discussed in more details on the blepharitis page.
Blepharitis...poorly spreading tears makes the eyes water. The blepharitis is a mild inflammation of the lower eyelid.
Lower lid position (laxity, entropian, ectropian)
A saggy or 'lax' lower eyelid may develop. This also can be corrected with a small operation in the outpatient department. Also, the eye lid may turn in (entropian) or out (ectropian). Minor eyelid surgery can correct the eyelid position.
Here are some of the causes, but there are others as below, or there may be a number of causes in combination.
Reduced drainage of tears
Reduced drainage of tears
Blocked naso-lacrimal duct
If the tear passages near the nose block, you may notice both
- a watery eye
- infections of the tear sac (called 'acute dacrocystitis')
The tear duct apparatus may block at any point along the tear passage, but the commonest place for a blockage is just below the tear sac. The cause of this blockage is not usually known. Sometimes the blockage is further down the at the exit of the nasolacrimal duct in the nose. Eye 18 diagram
The treatment that the doctor will recommend depends on how much the watery eye bothers you, and whether you find it very uncomfortable, or just a nuisance in the wind.
naso-lacrimal duct occlusion...one cause of watery eyes
Infection of the tear sac (acute dacrocystitis)
an infected nasolacrimal sac..a tender lump on the size of the nose
A few people with a blocked tear duct can develop an infection in the tear sac. This is quite uncomfortable, just like an abscess anywhere else in the body.
It is called 'acute dacrocystitis'. This begins as a blocked tear duct and watery eye. The tears then get trapped in the tear sac, and stagnate.
The stale tears may then become prone to infections.If you develop an infection in the tear sac, like any other abscess under the skin, you need treatment, as below.
The treatment for an infection of the tear sac.
- Bathe the 'abscess' with a hot flannel four times a day.
- See your GP for antibiotics
- co-amoxyclav 625mg three times a day 1 week if you are not allergic to penicillin
- Clarithromycin 500mg twice daily 1 week if you are allergic to penicillin
- If the abscess is rather severe you need to attend an Eye Emergency Department: sometimes the abscess needs draining.
After the infection.
After the attack of acute dacrocystitis and all the infection has gone,
the tears ducts may be open. However, the infection may damage the tear drainage, and the eyes
may be watery. In this case a DCR operation as below is necessary after you
have had acute dacrocystitis. The operation is carried out when the
infection has been treated.
Anyone with more than one episode of infection needs a DCR operation
unless there are contraindications (they are ill etc).
Treatment
DCR Operation: the operation to open the duct at the lower end
If the nasolacrimal duct is blocked, and if you are young or middle aged, and your eyes water and are uncomfortable much of the time, an operation can be helpful. Such patients would notice watery eyes at least 10 times a day.
Also, an operation is necessary after two episodes af acute dacrocystitis.
DCR surgery
This operation generally requires a general anaesthetic and an overnight stay in hospital. This is a 'DCR' operation, which translates into 'making a channel from the tear sac into the nose'.
One common operation is a cut on the skin over the tear sac, and then a small hole made in the bone between the tear sac and the nose. Next the surgeon connects the tear sac to the inside of the nose, and closes the cut in the skin. The skin scar fades and is usually nearly invisible after six months.
There are other types of operation, such as using balloons that can be blown up to expand the blocked tear duct. These may not be quite as successful, and are only available in a few hospitals. Alternatively the DCR operation can be carried out by using special instruments 'up the nose'.
Instructions after surgery. Leaflet DCRs operation
Frail people or no operation
If you are frail this operation is not generally recommended unless you have developed infections of the tear sac, as below. Even if you are well, if your watery eye is not really bothersome, you may prefer to manage as you are without having an operation. You may notice a small lump under the skin: the swollen tear sac. Unless there is an infection, you hardly feel the lump at all.
These is no harm in having watery eyes.
Less common causes of watery eyes
Blocked canaliculus
Blockages may develop in the canaliculi. More sophisticated surgery is needed.
Sometimes the entrance to the canaliculi can block.
The blockage can often be opened with a small operation.
In the nose
Uncommon causes of watery eyes include conditions inside the nose, such as polyps.
Professionals
Think of
- watery 10x day significant
- watery cold and windy..dry eye
- illness that cause dry eyes
- nasal congestion..try beconase
- measure tears see how wet
- syringe...see if tight, check punctum
- lid position