Tears play an important role in the health of our eyes as well as aiding clear vision. A deficit of tears leads to dry eye, which can significantly impact quality of life by causing discomfort and variable, blurry vision. But what about the opposite end of the spectrum when someone suffers excessively watery eyes?
What is Epiphora?
Epiphora is the medical term for watery eyes and the excessive production of tears. Epiphora can occur in one eye (unilateral) or both (bilateral), and often is asymmetrical, being worse in one eye than the other.
Watery eyes can be a reflexive reaction to some sort of temporary irritation to the eye, such as exposure to chemical fumes or a speck of dust. The rapid production of tears aims to flush away the irritant and protect the delicate surface of the eye.
However, some people suffer from persistently watery eyes, which makes it more likely they may require the attention of an oculoplastic surgery specialist.
What is Epiphora Caused By?
Watery eyes can be caused by a number of factors, though not all will require referral for oculoplastic surgery.
Causes of epiphora can include:
- Conjunctivitis: Conjunctivitis refers to an inflammatory condition of the conjunctiva, the translucent membrane that covers the whites of the eye. You may be familiar with infective conjunctivitis causes, such as a bacterial or viral conjunctivitis. Viral conjunctivitis often presents with watering and epiphora of the eye, accompanied by redness and itching or soreness. Allergic conjunctivitis is also commonly associated with epiphora, along with the hallmark itching and puffiness. You may also experience other symptoms of allergy, such as nasal symptoms.
- Trauma: If you’ve ever accidentally been poked in the eye, you’ll know that in addition to some significant pain and discomfort, your eye is likely to water profusely. As the surface of the eye is highly sensitive, it doesn’t take much to cause this reflexive reaction – even just brushing a finger against the cornea can trigger a watery eye.
- Dry eye: When discussing what is epiphora, it may be unexpected to encounter dry eye disease as a possible underlying cause. However, because the eye’s surface requires constant moisture and lubrication for good health, it makes sense for the body to have a reflexive mechanism to produce more tears when the cornea becomes dry. This results in a release of more fluid from the lacrimal gland, which can then end up overflowing. Treating the watery eye is then – counterintuitively – a matter of actually treating dry eyes, such as with artificial tear lubricants or warm compresses.
- Poor structure and/or function of the nasolacrimal system and eyelids: Epiphora due to changes to the tear duct (nasolacrimal) system and eyelids can be one of the more difficult causes to identify. If your optometrist or GP suspects issues along the nasolacrimal system as a contributing factor then you may be referred to a specialist in oculoplastic surgery.
Oculoplastic Surgery for Epiphora
The nasolacrimal system is involved in the production of tears as well as its drainage from the surface of the eye. There are multiple components of a healthy tear film, produced by various glands in different locations around the eyes. As all these components are secreted onto the surface of the eye, together they form the tear film, which aims to protect and lubricate the eye. Eventually, this tear film gathers along the lower eyelid due to gravity. From there, the blinking motion of our eyelids pushes what’s known as the tear prism, or tear lake, towards the inner corners of the eyes, where two tiny openings sit on the eyelid margins, known as puncta. Tears then drain through the puncta and, via a system of ducts and channels, through the nose and down the throat.
Issues with the nasolacrimal system and eyelids can contribute to epiphora, including:
- Weak or incomplete blinking: If the eyelids do not blink well, whether due to a disease such as Bell’s palsy that causes weakness of the facial nerves, or simply from lazy blinking, the tear lake is less efficiently drained through the puncta, leading to overflow of tears from the eye.
- Loose lower eyelids: With age, our skin loosens and can sag; the eyelids are no exception. If the lower eyelid does not sit well-positioned against the surface of the eye, it will have difficulty holding up the tear lake, resulting in these tears running down the cheek due to gravity. Additionally, a sagging lower eyelid, known as an ectropion, may result in the puncta also sitting away from the eye’s surface, making it difficult for tears to efficiently drain through it.
- Narrowing of the puncta: This can often occur due to age-related changes to our skin, where the opening of the puncta becomes smaller with time, impeding the drainage of tears.
- Narrowing or obstruction of the ducts: There are various locations where the nasolacrimal drainage channels may become narrowed or blocked, hindering the proper flow of tears through to the throat and resulting in a backlog and overflow of tears from the eye. These obstructions, whether full or partial, can be due to age, trauma, or even a growth or tumour.
An ophthalmologist experienced in oculoplastics is able to perform a thorough examination to determine what is your epiphora caused by and advise whether your condition is suitable for surgery.
Contact us today at (03) 9070 5753 to schedule your next appointment!
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.