Watery eyes – Tearing eyes
Excessive tearing is a common reason for seeking medical advice. While rarely serious, having a watery eye is nonetheless a significant source of discomfort for patients. The sensation of a full eye and tears running down the cheek may be due to either overproduction of tears or impaired drainage. Treatment for excessive tearing begins with addressing its underlying cause. This involves treating eye irritations to reduce reflex tearing and clearing blocked tear ducts if necessary. The specialist in excessive tearing is an oculoplastic ophthalmologist, meaning a specialist in the eyelids and tear ducts.
What is tearing?
Excessive tearing corresponds to an abnormal flow of tears due to an imbalance between their secretion and their drainage upon contact with the eye.
The two contributing factors are overproduction by the lacrimal glands, and impaired drainage by the lacrimal ducts.
A reminder about tears
Tears are the protective liquid envelope of the eye. Like saliva, tears are composed primarily of water. However, their composition is infinitely more complex, allowing them to remain stable vertically on the eye.
Tears are composed of 3 thin layers:
Aqueous layer – This is the thickest layer, composed of water and electrolytes.
Lipid layer – Anti-evaporative fatty agents limit the loss of surface tears.
Protein layer – Stabilizing compounds allow tears to adhere properly to the eye.
Diagnosis
The diagnosis of excessive tearing is clinical. It is usually made directly by the patient.
Clinically, the ophthalmologist observes an increase in the tear lake, that is to say a thickening of the tear film present on the edge of the lower eyelid.
The remainder of the consultation is intended to determine the cause.
Using a slit lamp, the ophthalmologist looks for signs of eye irritation, which causes reflex tearing.
He can instill a drop of dye called fluorescein, in order to see the behavior of the tears on the eye.
Finally, a test of the permeability of the lacrimal ducts can be carried out by injecting a product through the meatus (entrance of the lacrimal ducts) and seeing if it circulates into the nose.
Causes
It is necessary to distinguish between the causes of hypersecretion and the causes of drainage failure.
Causes of hypersecretion:
Eye irritations and trauma – The sensory nerve of the eye triggers a reflex overproduction of tears to aid healing.
Meibomian dysfunction and blepharitis – The lipid and protein phase of tears is not properly produced, resulting in hyperfluidity and reflex hypersecretion.
Allergies – The eye defends itself against allergens by triggering a reflex hypersecretion.
Dry eyes – Paradoxically, insufficient tear production is most often due to poor tear quality. Unstable tears cause irritation, leading to reflexive tearing.
Drainage failure:
Lacrimal duct obstruction – A canaliculus is blocked by a meatus (entrance) that is too tight, a clot, an infection or trauma.
Eyelid malposition – The eyelid does not close properly and does not direct the tears produced towards the meatus in cases of entropion or ectropion.
Symptoms
The symptoms most often reported by patients are:
The feeling of having one eye too full.
The flow of tears down the cheek.
Skin and eye irritations.
Intermittent blurred vision.
Treatments and surgery
The treatment for excessive tearing is to treat its cause! The most frequently used treatments are:
Artificial tears – To protect the eye, thicken tears and reduce reflex tearing.
Eyelid care – To improve meibum secretion and tear quality.
Anti-allergy medications – In case of associated allergic conjunctivitis.
Meatal dilators – Small, invisible and painless silicone tips used to dilate the entrance to the lacrimal ducts.
Lacrimal probes – Flexible silicone tubes keeping the entire lacrimal pathway patent.
Lacrimal duct surgery – In cases of severe lacrimal duct obstruction, a diversion of the lacrimal duct to the false nasal cavity can be performed. This is called dacryocystorhinostomy (DCR).
Complications
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Excessive tearing is a symptom that is often benign, but always uncomfortable.
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However, there are never any complications from tearing, only from its causes!
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For example, a corneal ulcer can degenerate into a corneal abscess if it becomes superinfected.