Excessive tearing, or epiphora, is an eye condition experienced by millions of Americans. There are various causes of epiphora and many ways to treat it. This article will examine what it is, the causes, and how you can find symptomatic relief.
What are Tears?
The tear film plays an essential role in eye health, helping to lubricate the eyes, wash away foreign particles, keep the cornea (the front surface of the eye) smooth and clear, and reduce the risk of infection.
Three layers make up tear film. The outer lipid layer secreted by the Meibomian glands keeps the cornea smooth and prevents tear evaporation. The middle aqueous (water) layer produced by the lacrimal glands keeps the eye clean and hydrated. The inner mucus layer produced by goblet cells of the conjunctiva helps tears spread and stick to the eye.
A typical days’ average basal tear production is approximately 10 fluid ounces.
The Lacrimal System
Once the tear film is produced and distributed across the eye, it drains into openings called lacrimal puncta located in the inner corner of both eyelids. The tears then move through tear ducts, the piping system of the eyelid, and empty into the nose.
This network of glands, sacs, and ducts around the eyes is known as the lacrimal apparatus or lacrimal system. The lacrimal gland, located near the upper outer corner of each eye, produces three types of tears:
- Basal tears (baseline tear production)
- Reflex tears (in response to surface irritants or dryness)
- Emotion tears (in response to emotional changes).
The lacrimal apparatus consists of a secretory and excretory system – one produces tears (secretory) and the other drains tears (excretory). A combination of nerves – the trigeminal nerve, facial nerve, sympathetic nerve, and parasympathetic nerve – help produce tears from the lacrimal gland. Meanwhile, the excretory lacrimal system drains tears via the puncta, ampulla, canaliculi, lacrimal sac, and nasolacrimal duct.
What Is Epiphora?
Epiphora occurs when there is an imbalance between tear production and tear drainage. You can think of epiphora as a plumbing issue. If there is a sink overflow, the faucets may be running, the drain may be clogged, or both!
According to the American Academy of Ophthalmology, epiphora is a condition that affects as many as 14% of people over 40 years of age. It can be unilateral (occurring in one eye) or bilateral (occurring in both eyes).
People who suffer from epiphora may experience tears running down the face, watery eyes, or a build-up of tears that requires constant wiping of the eyes. While in and of itself, it is not a vision-threatening condition, excessive tearing can become a nuisance and cause blurry vision, but it can also be a sign of a more serious issue.
Epiphora can be an acute or chronic condition. Constant eye watering should prompt a visit to an eye doctor for further evaluation.
What Causes Excessive Tearing?
Reactive tearing or excessive tear production is caused by various reasons, some of which are listed below.
- Chronic blepharitis
- Allergic conjunctivitis
- Dry eye syndrome
- Eyelid Malposition
- Entropion – eyelids turn inward toward the eyes
- Ectropion – eyelids turn outward away from the eyes
- Eyelid retraction – abnormal elevation of the upper eyelid or lowering of the lower eyelid
- Medications (Chemotherapy drugs, epinephrine)
- Viral infections (cold, flu, sinus infections)
- Corneal abrasion
- Corneal ulcer (keratitis)
- Viral or bacterial conjunctivitis (pink eye)
- Eye trauma
- Foreign objects in the eye (dirt, debris, chemicals)
A blocked tear duct can occur due to an obstruction anywhere within the lacrimal syste, which prevents tears from draining into the nose. This may occur due to several conditions, such as:
- Punctual stenosis – narrowing of the punctal opening
- Canalicular stenosis
- Nasolacrimal duct obstruction
- Eyelid trauma causing injury to the drainage system
- Nasal polyps or mass
A clinical examination is often necessary to determine the underlying cause of excessive tearing.
How to Stop Watery Eyes at Home
In the case of watery eyes from a viral infection or allergies, your symptoms may clear up without needing treatment. Similarly, excessive tears from an acute case of dry eye or eye irritation may benefit from over-the-counter artificial tears to keep your eyes lubricated.
As much of an annoyance as watery eyes can be, avoid rubbing your eyes or constantly touching your eyes with a tissue or rough surface. This can further aggravate whatever is causing the problem.
Contact an eye doctor if excessive tearing does not clear up after several days. You may need an examination to check for a clogged tear duct or other anatomical issue.
Treatment for Excessive Tearing
Treatment for excessive tearing depends on the cause. If allergies, dry eyes, or infection cause epiphora, medications can be used to treat the root cause. Foreign objects can be removed from the eye. In certain circumstances, botulinum toxin A (Botox is a popular brand of such medication) can be injected into the lacrimal gland to decrease tear production. Minor anatomical blockages can sometimes be dislodged using a probe or a rinse, but more serious anatomical issues often require surgical intervention of either the lacrimal system or the eyelids.
Various types of lacrimal procedures are available to treat a clogged tear duct.
Punctoplasty: This procedure involves dilating and surgically widening the punctum, the tear duct opening that can become narrowed and clogged.
Nasolacrimal stents: This procedure involves the placement of a small tube called a stent (usually made from silicone) within the nasolacrimal system to help hold open an access point for fluid outflow. The stent is temporary and left in place for several months before removal.
Dacryocystorhinostomy (DCR): This surgical procedure treats a complete obstruction when widening or stenting does not work or is not an option. A DCR creates a new route through the bone between your lacrimal sac and nasal cavity. This bypasses the existing clogged tear duct by allowing the tears to flow directly from the lacrimal sac into the nasal cavity. The procedure can be conducted either with a small incision in the skin (external DCR) or through the nose with a camera (endoscopic DCR). A stent is placed in the opening to support the new tear duct and is typically removed in two to three months.
Reconstructive Surgery for Eyelid Malposition
The structure of your eyelids can tear production and cause excessive tearing. Two of the most common types of eyelid malposition are entropion (an inward turning of the eyelid that causes eyelashes to rub against the eye) and ectropion (in which the lower eyelid turns outward and exposes the cornea to environmental hazards and disrupts the flow of tears). An ophthalmic plastic and reconstructive surgeon can treat eyelid malposition with reconstructive surgery to reposition or reconstruct the eyelid, reducing or eliminating the cause of epiphora.