This is a very common symptom for which there are a wide variety of causes. In general the problem results either from an over production of tears or reduced drainage of tears.
Causes of overproduction of tears
- Wind, smoke, fumes superficial foreign bodies
- Infections, allergic reactions
- “Dry” eyes
In effect, anything which irritates the eye such as a foreign body or a scratch to the ocular surface will result in epiphora. The watering is a protective mechanism to help clear debris away from the eye. Watering also occurs in emotive states or as a response to bright lights-even daylight. The most common cause of tear over-production is blepharitis; a condition in which there is an accumulation of debris along the lid margins with resultant inflammation and irritation. This can be treated with regular lid margin cleansing and may require courses of topical or oral antibiotics.
Tears are formed by the lacrimal gland, which lies beneath the outer part of the upper lid and by cells in the conjunctival surface of the eye-see diag.
Watering may occur at any age and results from a gradual narrowing of the upper end of the nasolacrimal duct, generally from chronic inflammation. Syringing the tear ducts may give temporary relief, but this is mainly used to aid diagnosis. Further tests like an X ray Dacryocystogram or dacryoscintillogram is often necessary to determine the nature of the obstruction.
As with children, the lacrimal duct can be probed in adults. However, in addition, small tubular stents may be inserted in an intubation procedure to keep the system patent. These may be left in position for several months before being easily removed in out patients. This is successful in 70% of cases.
Balloon catheter dilatation.
Here a catheter is passed into the duct and dilated widely. Often tubes are inserted as above to keep the system patent.
This is successful in 70% of cases.
DCR is carried out under general anaesthetic. The operation involves creation of an alternate channel for drainage of tears between the tear sac and nose, bypassing the blocked duct. At times, a silicone tube may be placed in the newly created passage to ensure its patency till it heals which may take 6-9 weeks. This tube is subsequently removed. This technique can also be performed through the nose by ENT surgeons.
This is successful in 75% of cases. Occasionally, the exact cause cannot be determined. In such cases, the patient may have to learn to live with the problem