Classification / type of disease:
Epidemiology:Watering eyes (tears rolling onto your cheeks) can occur at any age, but is most common in young babies and in people over the age of 60. It can occur in one or both eyes.
Presenting symptoms / signs: profuse watering
Diagnostic investigations:only severe cases investigated – inject a radio-opaque dye and Xray (identify narrowings/obstructions)
Making too many tears:Anything that irritates the eye can cause you to make a lot of tears. The watering is a protective reflex to help clear irritants away from the eye. For example:
- Chemical irritants such as onions, fumes, etc.
- Infection of the front of the eye (infective conjunctivitis).
- An allergy causing inflammation of the front of the eye (allergic conjunctivitis).
- A small injury or scratch to the front of the eye, or a piece of dirt or grit which gets stuck in the eye.
- Eyelashes that grow ‘inwards’ can irritate the front of the eye. This is called an entropion.
- Abnormalities of the tear film. For example, the lipid (fat) content of tears may not be right. The tear film may then not spread evenly across the front of the eye. This may cause patches of dryness to develop, which can become sore and make your eyes water.
- Thyroid eye disease
Faulty drainage of tears
- Tears may become blocked at any point in the drainage channels.
- The most common cause of watering eye in adults is a blockage in the tear duct just below the tear sac. This is thought to be due to a gradual narrowing of the upper end of the tear duct, perhaps caused by persistent mild inflammation.
- Sometimes the tear duct is not blocked fully, but is too narrow to drain all the tears.
- Less commonly there may be a blockage within the canaliculi, or the entrance to the canaliculi in the inner corner of the eye may be blocked. This may be due to inflammation or scarring.
- Rarely, a polyp in the nose may block the tears from coming out of the tear duct.
- Some babies are born with a tear duct which has not fully opened. This is common and usually clears within a few weeks without any treatment as the tear duct opens fully.
- Ectropion. This is where the lower eyelid turns outward away from the eye. The ectropion may cause tears to roll off the bottom of the eyelid rather than drain down the canaliculi to the tear sac.
Treatment / management:
Treating eye irritation
Quite often the cause can be treated.
- Eyelashes irritating the front of the eye (entropion) can be removed.
- Conjunctivitis can usually be treated with drops.
- Pieces of grit, etc, can be removed
Treating tear drainage problems
- Ectropion can usually be treated with a minor operation to the lower eyelid.
- Babies with watery eyes usually ‘grow out of it’ with no treatment.
- Blockage of the channels in adults.
- You may not need treatment if the watering is mild or does not bother you much.
- A blocked tear duct can be treated with an operation. The usual operation is called DCR (dacrocystorhinostomy) where a new channel is made from the tear sac to the inside of the nose. Tears then bypass any blockage further down the tear duct.
- A narrowed canaliculi which is not fully blocked may be widened by pushing in a probe. However, if it is completely blocked an operation is an option to drain the tears into the nose.