Watering Eye Information

Watering Eyes Excessive tearing or the bothersome problem of tears overflowing down the cheek is called epiphora (watering eye or watery eye). This can have many different causes. A careful clinical examination is performed to help to determine the underlying cause. Treatment will depend on the cause e.g. if the lower eyelid is sagging away from the eye (ectropion) and causing a watery eye, the treatment will be surgery designed to reposition the eyelid. Epiphora (watery eye) commonly develops from abnormalities in the lacrimal drainage system from scarring due to injury, recurrent infections, the ageing process, or from unknown causes. Surgery is required to improve watery eye which is caused by abnormalities in the tear drainage system. Occasionally a dacryocystogram (a special form of X-ray examination of the tear drainage pathway) or lacrimal scintigraphy (a test utilizing a radio-labelled tracer) is required to assist in your assessment.

Paradoxically a dry eye can lead to tearing. Glands in the eyelids (the Meibomian glands) secrete an oily material which coats the tears covering the cornea (the clear and extremely sensitive window at the front of the eye). The oily secretion slows down the evaporation of the tear film in between blinks. If these glands do not function properly (e.g. in blepharitis), the tear film evaporates quickly leaving the sensitive cornea exposed. The tear glands then produce an excessive volume of tears as a reflex which overwhelms the tear drainage system (as in emotional crying). This often leads to confusion with patients failing to understand why they have been prescribed artificial tears to improve their symptoms of watering of the eyes! There is a variety of artificial tear preparations available. Some patients prefer one preparation over another for no scientific reason. It is therefore wise to try different preparations. If the tears need to be used more frequently than 4 times a day it is better to choose preparation which is preservative free e.g. Viscotears preservative free, Hyabak drops, Hylotears, Liquifilm tears preservative free, or Celluvisc, and Lacrilube at bedtime.

The Lacrimal (Tear) System
The lacrimal glands, situated in the outer portion of the upper eyelids, produce the tears which drain downward and inward across the eye. Blinking of the lids helps to spread the tears to lubricate and protect the eyes. The tears drain into the superior and inferior puncta, located at the inner part of the upper and lower eyelids, and are carried by the superior and inferior canaliculi to the common canaliculus, and then into the lacrimal sac. The lacrimal sac is a small pouch located next to the nose. The tears then drain into the nose via the nasolacrimal duct (see figure below). A blockage at the lower end of the nasolacrimal duct is the most common cause of a tear drainage outflow problem leading to a watery eye.

The tear drainage pathway

Consultants who undertake private surgery for the management of a watering eye:

Saj Ataullah
Anne Cook
Brian Leatherbarrow
Ahmed Sadiq