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THE WATERING EYE: The chronic watery eye is a common complaint, especially in babies and elderly individuals. We will discuss the typical symptoms, the usual causes, what to expect when consulting your eye specialist with the problem of excessive tearing, and the available treatment. Tears are secreted by the lacrimal gland from the upper outer corner of the eye and flow downward and inward towards the drainage system situated at the inner corner of the eye. Through the action of gravity and the blinking action of the eyelids, tears drain via the tear duct system into the nose.
Excessive tearing or watering eyes (also called epiphora) is usually caused by one or two main mechanisms: Over-secretion of tears due to irritation to the eye such as ingrowing eyelashes (called reflex tearing), or by obstruction of the tear drainage system, with the resultant overflow of tears.
The typical signs and symptoms include:
1: Tearing in one eye (which is usually caused by obstruction) or excessive watering in both eyes (which is usually caused by irritation and subsequent reflex tearing), can result in softening and inflammation of the fragile skin surrounding the eyes, with crusting, chronic redness and discomfort of the skin.
2: The excessive tears can become infected and a discharge that is yellow and pussy can form. You should then refrain from touching your eyes and then touching doorknobs, towels and other objects used by family members and friends, to prevent spreading the infection.
3: The eye can become very itchy, and the usual culprit is chronic allergic eye disease.
4: Extreme sensitivity to light and a feeling of something foreign in one's eye should alert you to either a foreign body on the cornea, such as a metallic object from a grinder or a dust particle, or to disease of the cornea such as a viral ulcer or ingrowing eyelashes, and you should see your eye specialist as soon as possible to treat the above conditions.
5: One may also waken with their eyelashes stuck together or with crusts
on the eyelid-edges and eyelashes.6: Newborn babies may suffer from a thick, viscous or slimy discharge in one or both eyes. This is a fairly common problem, usually due to a partial obstruction of the drainage system. Most babies recover on their own before 10 months age with the help of specific eyedrops and careful massage of
the lacrimal sac in a downwards direction towards the nose. The tear sac
(or lacrimal sac) lies on the inner aspect of the eye adjacent to the nose.
The exact technique of massaging can be demonstrated by your eye specialist. If the above measures do not relieve the symptoms, and baby is older than 10 to 12 months, your ophthalmologist might have to irrigate
and dilate the drainage system under general anaesthesia. The majority of
babies recover completely after the above treatment. Irrigation and dilation are rarely necessary before the age of 10 months.7: Paralysis of the nerve to the facial muscles with weakening of the
muscles around the eye that keep the eyelids against the eyeballs, can
result in eversion (turning out) of the lower eyelid. This prevents the tears from draining properly and causes overflow. These eye-muscles can also weaken due to aging, with eversion of the lower lids similar to facial palsy and with the same result. This condition is called ectropion of the lids.8: Patients with abnormalities of their tear film (such as an inadequate lipid component) may develop dry spots on their corneas with subsequent reflex oversecretion of tears and a watery eye!
When you visit your ophthalmologist complaining of watering eyes, he will examine your eyes and tear duct system using an instrument called a slit-lamp through which he can view these structures under high magnification. He will instill a special dye in your eyes and evaluate the drainage of the dye. If necessary, he might irrigate the tear-duct system using a syringe with a special needle to see if there is any obstruction to outflow. If obstruction is detected, he might send you for special x-rays to check where the obstruction is situated.
The treatment of a watery eye depends on the cause. If there is any obstruction, this will be relieved by dilating the tear duct openings and irrigating the tear ducts with a saline solution, and if that is unsuccessful, your doctor will proceed to probe the drainage system and may leave a
small silicone tube in at times, to keep the ducts open. If this is unsuccessful, you may need an operation to open the drainage system. This is known as a dacro-cystorhinostomy. Usually however, only a very small minority of patients need surgery.If you have any further questions regarding watering eyes, please consult your eye specialist.