Tearing of the eye is a very common symptom that patients come to see Dr. Ahmad for.  Tearing of the eye is more than just a nuisance.  It can cause blurry vision especially in people who perform close up work. Patients with tearing can have diffiuculty driving (especially at night) and trouble on the computer. It can also cause chronic eyelid skin irritation and even in some patients a darkening of the lower eyelid skin.  Women who have tearing are unable to wear make up or eye products because the build up of tears washes off the product. Probably the most common complaint is the social embarressement from tears running down the face.

Causes of Tearing

Tearing of the eye can be either from Overproduction of tears or from poor drainage of tears.

Anatomy-Tears are made in the Lacrimal Gland which is located in the upper eyelid.  Blinking of the eyelids pushes your tears into the corner of the eyes where they drain thru small openings called Puncta.   The puncta connect to small canals called canaliculi. The canaliculi join together and enter the tear sac which sits in the bone on the side of the nose.  As we age the tear sac often plugs and causes tearing or recurrent infections.

Overproduction

The most common cause of overproduction of tears is dryness of the eye.  This is often called Dry Eye Syndrome or Keratitis Sicca.  This is extrememly confusing for patients!! Why doctor does my eye water so much if it really is dry?  The reason is simple.  A dry ocular surface will try to increase tear production, this over production of tears can overwhelm the drainage system leading to a build up of tears(A Watery Eye) or run down the face(True Epiphora). Patients who have tearing from a dry eye can benefit from ocular lubricants especially preservative free tear drops. Sometimes patients will also have Blepharitis. Blepharitis is a inflammation of the eyelids that can present as debris on the lashes, plugging of the oild glands or a build up of foamy oil in the corners of the eyelids.  Blepharitis can also cause tearing or burning of the eye!! Blepharitis is a chronic condition that can be improved with warm heat to the eyelids or baby shampoo scrubs to the lash line. Once again ocular lubricants can be extremely helpful in decreasing the eyelid or eye inflammation that leads to a watery eye.

Poor Drainage of Tears

The drainage of tears from our eyes is a relatively complex system which requires nice tight eyelids and a open drain.  What is the drain in our eye?  Well in the corners of the upper and lower eyelids are small holes called Punctum. Punctum are the openings that bring tears into the tear drainage system which is also called  the lacrimal system.  Some patients can have punctal stenosis which is where these openings become closed.  The punctum connect to the canaliculi which are small pipes in the corners of the eyelid that connect to the lacrimal sac which sits in the bone of the corner of the eye. This bone is called the maxilla.  The lacrimal sac drains into the nose thru an opening in the nose.  Small babies often have tearing which is from blockage of this small hole in the nose that can be opened by probing this system.

The drainage system can get plugged anywhere from the punctum, canaliculi, lacrimal sac and the opening in the nose.  Each requires a different surgery to try to open the clogged area.  Younger patients who have repeated red eye may develop closure of the canaliculi.  Middle aged and older patients may have closure of the lacrimal system in the nose which requires a Dacryocystorhinostomy. Dr. Ahmad will examine the tear drainage system during your initial consultation.  This will require irrigating your drainage system with fluid to make sure it is working well.  Most patients have very minimal pain with this procedure.

Poor Flow of Tears

Our eyelid blink mechanism is very important for drainage of tears. Patients with a Bells Palsy or Facial Nerve Palsy will often comment on the fact that their eye is tearing. This is because when you lose the ability to close your eyelids fully or have a decreased blink frequency the tears will not flow into the tear duct openings(Punctum).  As we age our eyelids become lax or floppy, very often the lower eyelid will sag.  This aging change can reduce tear flow.  Tightening of the lower eyelid is a very common technique to restore the natural shape and function of the eyelid which can improve tear drainage.

Overproduction and Poor Drainage of Tear(Multiple Issus causing tearing)

There are some patients who have tearing from a combination of problems. This could be a patient who has floppy or lax eyelids as well as a partially or completely blocked tear duct!  Many patients may require more than one procedure to improve tearing.  It is important for patients to remember that the tearing eye may not completlly improve but may improve only to some degree.