What is Epiphora (Watery Eyes)?

Epiphora is the term commonly used to describe a watery eye. It is one of the most common eye symptoms and has many causes. In this condition tears spill over and overwhelm the eye’s drainage system. This may be due to blocked drainage of the eye or a defect in the lacrimal pump function. This condition can interfere with vision and irritation of the surrounding skin due to constant wiping of tears.

 

What is the cause of Epiphora

Overproduction of tears:

  • Abnormal lid or lash position (trichiasis or entropion).

  • Blepharitis

  • Tear film deficiency with reflex tearing.

  • Corneal foreign body

  • Conjunctivitis

  • Corneal disease.

  • Inflammatory disease of the eye (scleritis, uveitis)

  • Damage to the facial nerve and paralysis of the whole eyelid with lacrimal pump failure

Stenosis or obstruction at any point along the nasolacrimal duct:

  • Congenital nasolacrimal duct obstruction

  • Lacrimal sac mass or mucocele

  • Dacryocystitis (inflammation of the lacrimal sac)

  • Nasal obstruction (mass, inflammation or scarring.)

  • Previous surgery or trauma of the nose or eyelids.

 

Symptoms of Epiphora

  • Tear spillage from both inside and outside corners of the eye

  • Abnormal eyelid position

  • Increased watering of the eye with focused task that involve reduced blinking (e.g. computer work)

  • Runny Nose

  • Tearing with thoughts of food or eating (due to facial nerve damage and aberrant regeneration – “crocodile tears”)

 

Diagnosis:

  • Fluorescein disappearance test: a tiny drop of fluorescein 2% is instilled then left on the eye for 5 min. Then the doctor looks at your eye with a slit lamp to evaluate the dilution and distribution of the dye. This can identify any problems with the tear fluid or damage to the cornea.

  • Syringing: irrigating the nasolacrimal gland to evaluate patency and flush out mucus.

  • CT, MRI scans and nasoendoscopy may be undertaken if sinonasal disease or tumours are suspected

 

Treatment

  • Treat underlying cause. Treatment will with vary depending on aetiology e.g. epilation of abnormal lashes, cautery for punctal ectropion.

  • Probing and flushing of the nasolacrimal gland helps in most cases of blocked lacrimal ducts. More advanced surgeries are available if this simple office procedure is not effective and will require referral to a specialist oculoplastics surgeon.

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The Conservatory Annexe

Marlborough, Wiltshire

SN8 4BY

Telephone: 01672 515 713

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