Excessive lacrimation or epiphora is determined by the hypersecretion of the lacrimal gland or the impossibility of adequate drainage of tears, through the nasolacrimal ducts, and can be present in one or both eyes. The lacrimal glands are accessories that generate the basal lacrimal secretion to maintain an optimal level of hydration of the eyeballs, also ensuring their protection by generating the precorneal tear film. The main lacrimal glands ensure reflex lacrimal secretion, with the role of lubricating and removing irritating foreign particles from the surface of the cornea, and are involved in the physiological process of generating tears during crying.
When does hyper lacrimation become a problem?
When should I go to the ophthalmologist?
Excessive lacrimation treatment
After the synthesis, the tears are drained at the nasal level by means of the tear ducts located in the inner corner of the eyes on one side and on the other of the root of the nose.
Hyper lacrimation can be caused by exposure to irritants, allergens, viral or bacterial infections, blockages or development anomalies of the lacrimal duct that cannot effectively take over and drain the physiological lacrimal secretion.
When does hyper lacrimation become a problem?
In most situations, the tearing of the eyes is temporary and goes away without treatment, but there are also cases in which patients complain of eye pain and blurred vision. Other symptoms that can accompany hyperlacrimation are represented by conjunctival hyperemia (redness), palpebral edema and visible dilation of blood vessels in the eyeball. In the presence of this symptomatology, a specialized ophthalmological consultation becomes necessary, to establish the cause that causes hyper lacrimation and to establish an appropriate treatment plan for each individual patient.
Foreign bodies in the eye can cause the appearance of hyper lacrimation with tears running down the cheek – epiphora and require presentation to the ophthalmologist for their extraction, respectively, the administration of treatment to prevent the occurrence of further complications.
Why are my eyes watering?
Excessive tearing can be determined by several factors, among the most common causes of this manifestation, being found:
- Exposure to allergens: dust, pollen, molds
- Viral or bacterial eye infections
- Dry eye syndrome which paradoxically causes an increase in the production of lacrimal secretions
- Ectropion or entropion (eyelid turned outwards, respectively inwards)
- Blepharitis
- Keratitis
- Corneal ulcer
- Eye damage: chemical burns, traumas
- The presence of foreign bodies in the eye
- Obstruction of the nasolacrimal ducts, congenital or acquired
- Tumors of the nasolacrimal duct
Other causes that can cause excessive tearing are represented by inflammatory conditions such as sarcoidosis, Wegener’s granulomatosis and rheumatoid arthritis, Bell’s palsy, chronic sinusitis, radiotherapy in the head area, Sjogren’s syndrome, upper respiratory tract infections, nasal pyramid fracture or surgical interventions that cause accidental damage to the nasolacrimal duct.
When should I go to the ophthalmologist?
Sharp eye pain, blurred vision, edema and the persistent sensation of a foreign body that accompanies hyper lacrimation are the main reasons for concern that require examination and specialized medical care.
Excessive lacrimation can affect the patient’s quality of life, especially in situations where he carries out activities that involve driving or handling heavy machinery, due to the risk of injury that occurs in the presence of blurred vision.
Excessive lacrimation treatment
Epiphora in newborns presents a self-limited evolution and disappears spontaneously without specific therapy. In infants, the time required for the complete opening of the tear ducts can be several months, sometimes it is necessary to clean the child’s eyes several times a day with sterile cotton moistened with physiological serum.
The treatment of excessive lacrimation is etiological and addresses the cause that induces the appearance of the manifestations. Depending on the recommendations of the specialist, the therapy may include:
- The administration of antibiotics in bacterial eye infections that cause hyperlacrimation
- The use of eye drops with artificial tears in the case of patients who are diagnosed with dry eye syndrome
- Removal of foreign bodies accidentally reaching the eyeball and, if necessary, surgical reconstruction of the damaged structures
- Re-permeabilization of the nasolacrimal ducts with the help of saline solutions. In certain situations, the ophthalmologist can remove the obstruction manually, with the help of special tools. Extensive blockages of the nasolacrimal duct benefit from surgical intervention for repermeability
- Blepharoplasty: eyelid reconstruction surgery if hyper lacrimation is caused by an extropion or entropion (turning of the eyelid inwards or outwards)
In the case of children younger than 1 year who present hyperlacrimation due to congenital obstruction of the nasolacrimal duct, the doctor may recommend gentle manual compression 4-5 times a day to remove the distal blockage.
If these maneuvers are not successful after the age of 1-year, surgical intervention for probing the nasolacrimal duct under general anesthesia is recommended. Recurrent obstructions of the nasolacrimal duct that cause hyperlacrimation can be treated by inserting a temporary drain tube to prevent restenosis of the duct and ensure proper drainage of lacrimal secretions.
Acquired obstructions of the nasolacrimal duct can be treated by irrigation and, as a last resort, surgical intervention can be performed to create a passage between the lacrimal sac and the nasal cavity (dacryocystorhinostomy – (DCRS), in severe cases that do not show a favorable response to other methods of treatment.
In the situation where hyperlacrimation occurs in the context of seasonal allergies, it is indicated to avoid exposure to the triggering factors – for example, pollen during the spring, at the same time anti-allergic medication can be administered to reduce the immune response and relieve symptoms. Antihistamines, decongestants and immunotherapy are some therapeutic options successfully applied to patients with hyper lacrimation of allergic etiology.
References:
- Eyestrain, Mayo Clinic
- The Watery Eye
- Watering eyes, NHS
