Watery eye

• What is epiphora (watery eye)?

Epiphora is an overflow of tears onto the face. A clinical sign or condition that constitutes insufficient tear drainage from the eyes in that tears will drain down the face rather than through the nasolacrimal system.

• How do tears normally drain away from the surface of the eye?

The surface of the eye and insides of the eyelids are mucous membranes which by definition should be moist at all times. This moisture is provided by tears that are made by the lacrimal gland, a specialised gland located under the outer one-third of the upper eyelid.

Throughout the day when we blink, the tears are spread across the eye and slowly pushed toward the inside corner next to the nose.

On the inside corner of each eyelid there is a small drainage port called the punctum.

We can see this opening if we look closely in the mirror and gently pull the lid away from the eye.

Each punctum leads to a short horizontal drainage canal (the canaliculus) which leads to a drainage sac deep under the skin at the inner corner of the eye (the lacrimal sac).

Finally, this sac drains downwards (via the nasolacrimal duct – the tear duct), through the bone of the side of the nose into the nose. This is the reason why the nose runs when someone cries.

Causes and treatment of epiphora

Causes of epiphora are any that cause overproduction of tears, decreased drainage of tears or pump failure, resulting in tearing onto the cheek.

Overproduction of tears
Evaporative dry eye, or reflex tearing.

Decreased drainage of tears
Narrowing/ blockage along the lacrimal drainage system

Any narrowing, irregularity, or obstruction along the lacrimal drainage system may lead to a wet or watery eye, either in specific conditions (such as cold, windy weather), or on a more constant basis. Other common symptoms include mucous buildup at the inside corner of the eye and/or along the lashes, and distorted vision. Dr Mavrikakis can perform tests to determine if there is a narrowing or blockage and if so, where between the eye and nose the problem lies.

The exact location of the narrowing or blockage will determine what treatment options are available to you. In most cases, a surgical procedure will be required to either alleviate or bypass the obstruction.

Pump failure
If the lids are malpositioned (entropion, ectropion etc) or weak or loose from age (eyelid laxity), paralysis (facial nerve palsy) or injury, they may not blink as well. Without a proper blink mechanism, the tears have a hard time finding their way to the drainage port at the inside corner.

In this situation, Dr Mavrikakis will advise on the appropriate surgical procedure to correct the underlying condition and improve the drainage mechanics.