Teary Eyes - Causes, Diagnosis and Treatment

Dealing with Teary Eyes

Dr.Sreelakshmi Nimmagadda profile Authored by Dr.Sreelakshmi Nimmagadda on 2 Feb 2015 - 13:37.

Eyes water when we are extremely happy or sad and we call it tears of joy or sorrow. But it is considered abnormal when there is down pour or over flow of tears irrespective of our emotions.

Nowadays the most commonly encountered problem is watering or tearing of  the eyes no matter what  the age is or the profession we are into. Under normal circumstances the quantity of  tears secreted should equal the quantity eliminated. When this balance is maintained, neither a dry eye nor a watery eye symptoms occur.

In a day approximately, 10ml of tears are secreted by the tear glands. Most of these tears get evaporated and a small quantity is pumped along  the lid margins into the openings located at the inner corners  of both upper and lower lids into the nose. Some conditions lead to excessive tearing.

Causes of excessive tearing can be due to excessive secretion of tears or decreased tear elimination. Due to excessive secretion of tears could be due to:

While dryness of the eye is induced by excessive usage of computers, watching television, surgical procedures laser surgeries,  cataract operations, certain medications  etc.

Treatment is directed towards the underlying causes that include antibiotics in case of infections, removal of foreig bodies, prescription of glasses for refractive errors , lubricating eye drops for dry eyes etc.  

Decreased tear elimination happens due to

  • Poor lid muscle tone, in old age or due to lid trauma
  • Blocked opening due to trauma, infections of the eyelid and nose, tumors of the eye or the nose, radiotherapy, chemotherapy etc.
  • Obstruction of the tear drainage system (obstruction of the lacrimal sac and duct): Blockage of this passage anywhere at the opening to the duct. By definition this means the blockage of the tear disposal system of the eye. This  consists of  eyelids and its muscles, two openings in both upper and lower lid margins which are connected to narrow passages or tubes to form a common duct which is situated in upper part of the nose. This can be congenital (present from birth) or acquired.   

Congenital Obstruction:

This is due to an imperforate membrane, which usually opens spontaneously (90% of the time) at the time of birth. Sometimes, this may persist well into the adult life. If spontaneous resolution does not occur by one year of age, a very simple procedure, called probing is advised.The success rate for this procedure is greater than 90 percent. Till then a digital massage over the sac area  (the space between the eye and the bridge of the nose) is done by the mother along with the use of antibiotics usually Tobramycin Drops. The success rate of probing decreases if a child has passed the age of 5 or 6 years.

Acquired Obstruction:

Causes:  
This is most common in adults due to bacterial infections. Inflammatory diseases like Sarcoidosis, Trauma, Post-surgery like in the case of rhinoplasty, nasal and endoscopic surgery etc. This is known as Dacryocystitis and it is presented with watering,  discharge sometimes pain and redness on the affected area.

A simple painless test known as syringing is done to diagnose this condition where normal saline is flushed into the opening of the eyelid, when the taste of the fluid is experienced into the throat. This means your drainage system is perfect and most of us experience this feeling when we instil eye drops in the eyes. If you don’t get the fluid into the throat or through the nose, then it indicates a block in the drainage path. This condition must be treated otherwise, severe infection can spread to the whole of the eye.

Surgery is the preferred choice of treatment for teary eyes, a procedure called Dacrocytorhinostomy ( DCR). This  technique creates a  new route for tears to drain out through the nose by developing a connection into the sac, bypassing the duct where the exact blockage may be present. The sutures are removed after one week. ENT surgeons have a different approach where sutures are not used. They use endonasal DCR which has significant recurrence rate.

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.