Watering eyes are a common problem, particularly in older people. A blocked tear duct is the most common cause, but there are a number of other causes. You may not need treatment if symptoms are mild. An operation can usually cure a blocked tear duct. Other treatments depend on the cause.
Watering eyes (tears rolling on to your cheeks) can occur at any age, but are most common in young babies and in people over the age of 60. It can occur in one or both eyes.
Just above, and to the outer side, of each eye is a small gland called the lacrimal gland. This constantly makes a small amount of tears. When you blink, the eyelid spreads the tears over the front of the eye to keep it moist. The tears then drain down small channels (canaliculi) on the inner side of the eye into a tear sac. From here they flow down a channel called the tear duct (also called the nasolacrimal duct) into the nose.
What are the possible causes of watering eyes?
-Emotion can make you cry. 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.
-Chemical irritants such as onions, fumes
-Infection of the front of the eye (infective conjunctivitis).
-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 (see Entropion)
-Thyroid eye disease is an uncommon cause.
-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. If you have a blocked tear duct, not only will you have watering eyes, but the stagnant tears within the tear sac may become infected. If the tear sac gets infected you will also have a sticky discharge on the eye. You may also develop a painful swelling on the side of the nose next to the eye.
-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 small channels (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 occurs 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. See the separate leaflet called Ectropion.
Do I need any tests?
Sometimes the cause is easily identified – for example, infections, ectropion, entropion, and conjunctivitis. If there is no obvious cause revealed by a simple examination, further tests may be advised (clinical exams, radiographs...).
What is the treatment for watering eyes?
Treating eye irritation
-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 dacrocystorhinostomy (DCR). In this operation a new passage is made between your tear sac and your nose and this bypasses any blockage below your tear sac and allows tears to drain normally again.
DCR surgery is worthwhile if the watering is bad enough to interfere with your activities of daily living. It is also recommended if you have had an infection in your tear sac as a result of the blocked tear duct. The surgery may prevent repeated attacks of a red, painful swelling at the corner of your eye.
There are two ways of doing this surgery, either externally – through your skin or endoscopically – from within your nostril. Your doctor will be able to give you more information regarding this.
A narrowed small channel (canaliculus) 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.
Tear duct surgery, or dacryocystorhinostomy (DCR), is a surgical procedure performed by ophthalmolgists to unblock or drain obstructed or infected tear ducts or other portions of the tear (lacrimal) system. A blockage of the tear system can result in excessive tearing, lack of tears, or infection within the drainage system. Tear duct surgery is more commnly seen in pediatric ophthalmology.
How Tear Ducts Become Blocked
Tears are necessary for keeping the eyes healthy and moist. They are produced from a gland under the upper eyelid called the lacrimal gland and drain into tiny holes (lacrimal puncta) in the inner corner where the upper and lower eyelids meet.
As we blink, tears are pumped into the nose through the tear duct (nasolacrimal duct) and are reabsorbed into the body. The nasolacrimal duct can become obstructed preventing normal tear drainage and increasing the risk of eye inflammation and infection.
Common Causes of Tear Duct Blockage
Tear ducts can become obstructed without presenting an obvious reason. The blockage can be partial or total, and can occur anywhere within the tear drainage system.
Common causes include:
-Aging: Over time, the puncta (openings to the tear ducts) can narrow and cause blockage
-Infection: Can cause inflammation and blockage
-Previous surgery or injury: Scarring or bone damage can obstruct tear flow
-Loose skin cells or dirt particles: Can become lodged in the tear ducts
-Medicated eye drops: Prolonged use of some medicines can result in blockage
-Cancer treatment: Tear ducts can be affected by radiation or chemotherapy treatments
Symptoms of Nasolacrimal Duct Obstruction (Blocked Tear Duct)
Patients may be unaware of symptoms at the onset of nasolacrimal duct obstruction. They may notice that their eyes are watering, but not realize that the overproduction of tears is actually a blocked tear duct. While a blockage may resolve on its own, it can also result in ongoing infections within the lacrimal sac (which collects the tears), eye inflammation, and mucous build-up.
Diagnosing Nasolacrimal Duct Obstruction (Blocked Tear Duct)
Diagnosing a blocked tear duct will involve discovering where the blockage is located within the lacrimal system. If a blocked tear duct is suspected, your doctor will conduct a tear drainage test to measure if your tears are draining properly. One drop of a harmless dye is placed on the eye’s surface and observed. The amount of the dye that drains off the eye will determine if the duct is blocked.
Other tests that may be used to diagnose a blocked tear duct include:
Probing and irrigation: A thin tube (probe) is placed into the lacrimal system to determine if the duct is open. A saline solution is then flushed through the nasolacrimal duct to test if tear drainage is normal.
Imaging tests: X-ray, CT scan, or MRI may be used to track a special dye placed in the tear drainage system and locate any blockage.
Treatment for Nasolacrimal Duct Obstruction (Blocked Tear Duct)
Treating an obstruction in the tear drainage system often requires tear duct surgery, a surgical procedure, to unblock the nasolacrimal duct. This tear drainage surgery is called a dacryocystorhinostomy (DCR). If the tear duct is partially blocked, your doctor may try to open the duct by flushing water through it. If this is unsuccessful or if the duct is completely blocked, tear drainage surgery is typically the most effective treatment.
Types of tear duct surgery include:
External DCR: A small incision is made on the top side of the nose near the bridge. The doctor removes a tiny piece of bone to allow drainage between the lacrimal sac and the nose. In some cases, a temporary tube is inserted into the opening to prevent scarring and to keep the duct open. The opening is closed with sutures and the tube is removed about 8 weeks later.
Endoscopic or endonasal DCR: Tear drainage surgery performed through the nose utilizing an endoscope, a small tube with a tiny camera and light attached. The endoscopic procedure is performed similarly to external DCR without the skin incision.
Dacryocystorhinostomy is typically performed as an outpatient procedure under general anesthesia.