Watery Eyes in Adults (Epiphora) David Kinshuck |
An explanation of the common causes of watery eyes, and related problems. |
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Normal tears |
Tears are made in a gland under the skin above the eye. They flow over the front surface of the eye, and drain into tiny tear ducts in the eyelids, near the nose (under the skin). The tears then flow into a tear sac, and from there they pass through a wide channel, the naso-lacrimal duct into the inside of the nose. See Animation. |
healthy tear flow over the eye into the nose: |
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Symptoms |
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Main causes of watery eyes (epiphora) |
The causes often occur in combination |
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Too many tears |
There are some conditions that can cause your eye make too many
tears. Many people with watery eyes have a combination of too many
tears and blocked tear duct. Conditions that 'cause' watery eyes
include
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Irritation...ingrowing lashes and dry eyes and other causes |
In-growing eyelashes (trichiasis) In-growing eyelashes or anything that irritates the eye may cause a watery eye.. In-growing lashes need to be removed, although they may grow in again. Dry eyes Surprisingly, if your eyes are dry you may notice watery eyes: your eyes become sore and this makes your eye make more tears. But these tears may not spread properly, and dry patches develop on the surface of the eyes (as below). Using artificial tears can help make the eye feel a lot more comfortable; the artificial tears may spread more evenly, and you can buy them from the chemist. See 'dry eye'. Gel type of artificial tears are generally best to try first.
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Blepharitis....causing poorly spreading tears |
Blepharitis is the medical term for inflamed eyelids. The inflammation is like eczema of the skin, with red, scaly eyelids. You may notice watery, tired, or gritty eyes, which may be uncomfortable in sunlight or a smoky atmosphere. They may be slightly red, and feel as though there is something in them. The eyelids have tiny glands in them, especially the lower lids. These glands make substances that mix with tears, and help the tears to spread across the eye. If these glands are blocked they will not release these chemicals (wetting agents). The tears then become too thin and do not spread evenly across the eye dry patches may develop on the surface of the eye. These dry patches make the eye feel sore and then your eyes may start to water. This is discussed in more details on the blepharitis page.
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Lower lid position (laxity, entropian, ectropian) |
A saggy or lax lower eyelid may develop. This also can be corrected with a small operation in the outpatient department. Also, the eye lid may turn in (entropian) or out (ectropian). Minor eyelid surgery can correct the eyelid position. |
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Blocked naso-lacrimal duct |
If the tear passages near the nose block, you may notice both
The tear duct apparatus may block at any point along the tear passage, but the commonest place for a blockage is just below the tear sac. The cause of this blockage is not usually known. The treatment that the doctor will recommend depends on how much the watery eye bothers you, and whether you find it very uncomfortable, or just a nuisance in the wind. |
A partial or functional blockage or 'pump failure' |
This is essentially a combination of the problems above. The (naso-lacrimal)
tear duct is open, but not quite wide enough to drain away all the
tears.
This may be due to problems such as reduced blinking or weak muscles in the eyelids. This is called pump failure. It is treated in the same way: if the watery eyes are very bothersome and you are young and fit, DCR surgery as below may help. If you are not really bothered, then surgery is best avoided. |
DCR Operation: the operation to open the duct at the lower end |
If the nasolacrimal duct is blocked, and if you are young or middle aged, and your eyes water and are uncomfortable much of the time, an operation can be helpful. Such patients would notice watery eyes at least 10 times a day. This operation generally requires a general anaesthetic and an overnight stay in hospital. This is a DCR operation, which translates into making a channel from the tear sac into the nose. A cut on the skin is made over the tear sac, and then a small hole is made in the bone between the tear sac and the nose. Next the surgeon connects the tear sac to the inside of the nose, and closes the cut in the skin. The skin scar fades and is usually nearly invisible after six months. There are other types of operation, such as using balloons that can be blown up to expand the blocked tear duct. These may not be quite as successful, and are only available in a few hospitals. Alternatively the DCR operation can be carried out by using special instruments 'up the nose'. Instructions after surgery. Leaflet DCRs operation |
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Older people or no operation |
If you are older (e.g. 70 years old) this operation is not generally recommended unless you have developed infections of the tear sac, as below. Even if you are younger, if your watery eye is not really bothersome, you may prefer to manage as you are without having an operation. You may notice a small lump under the skin: the swollen tear sac. Unless there
is an infection, you hardly feel the lump
at all. |
Infection of the tear sac (acute dacrocystitis) |
A few people with a blocked tear duct can develop an infection in the tear sac. This is quite uncomfortable, just like an abscess anywhere else in the body. It is called acute dacrocystitis. This begins as a blocked tear duct and watery eye. The tears then get trapped in the tear sac, and stagnate. The stale tears may then become prone to infections.If you develop an infection in the tear sac, like any other abscess under the skin, you need treatment, as below. |
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The treatment for an infection of the tear sac. |
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After the infection. |
After the attack of dacrocystitis and all the infection has gone, the tears ducts may be open. However, the infection may damage the tear drainage, and the eyes may be watery. In this case a DCR operation is necessary after you have had acute dacrocystitis. The operation is carried out when the infection has been treated. Anyone with more than one episode of infection needs a DCR operation unless there are contraindications (they are ill etc). |
Less common causes of watery eyes |
Blocked canaliculus |
Blockages may develop in the canaliculi. More sophisticated surgery is needed.
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Sometimes the entrance to the canaliculi can block. The blockage can often be opened with a small operation.
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In the nose |
Uncommon causes of watery eyes include conditions inside the nose, such as polyps.
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Leaflet |
This is a slightly old version of this page in a leaflet form: 200k AdobePDF |
The address of this site ('org' changing to 'nhs') is changing from http://www.goodhope.org.uk/departments/eyedept/ to http://www.goodhope.nhs.uk/departments/eyedept/ |
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