Watery Eye
Introduction
Watery eye is a common eye complaint, and it can be due to many factors and conditions.
Main Causes
Hypersecretion/reflex tearing causing eye to produce excess tear.- The commonest cause is dry eye, other causes include eyelid malposition (e.g. ectropion, entropion), ingrown eyelashes (trichiasis), allergic conjunctivitis, eye infection, blepharitis, ocular surface disease or foreign object in the eye.
- It can be congenital or acquired, unilateral or bilateral.
- Congenital blocked tear duct affects as many as 20% children aged <1 year worldwide and 90% of them usually resolved without surgery.
- Acquired blocked tear duct may be age related, due to facial trauma, infection or inflammation (sarcoidosis), sinusitis, tumour at the tear drainage system, previous eyelid or nose surgery or glaucoma eyedrops.
NOTE: In older adults, aging skin around the eyelids can sag away from the eyeball, allowing tears to accumulate and overflow, causing persistent watery eyes.
Hypersecretion
Treatment for watery eyes depends on the underlying cause. For example,
- Lubricating eye drops soothe dry eyes.
- Antibiotics eye drops combat infections.
- Removing foreign objects restores normal tear flow.
- Surgery may be necessary for eyelid malposition.
Blocked Tear Duct
In patients with blocked tear ducts, stagnant tears accumulate in the drainage system and become susceptible to bacterial, viral, or fungal infections.
- This can lead to recurring eye infections and inflammation of the tear sac, known as dacryocystitis.
- Patients usually present with constantly overflowing tears, mucus or pus discharge in the tears, painful swellings near the inside of the eye, blurred vision or crusting of the eyelids.
- Symptom of watery eye in blocked tear duct is worsened by cold weather, wind, common cold or sinus infections.
Diagnosis involves syringing tests, dacryocystography (DCG), X-ray or CT scan of the tear duct area.
- Syringing tests - A special fluid is flushed into the affected tear duct opening and if the fluid cannot be tasted in the nose or throat, a blocked tear duct is diagnosed.
Not all cases will resolved spontaneously, but it is almost always correctable.
- The treatments depend on the cause of blockage and the age of patient.
- If the tear duct is completely blocked, a surgical procedure called dacryocystorhinostomy (DCR) may be necessary. DCR creates a new tear drainage between your eye and your nose, bypassing the blockage. This surgery can be performed using either an external incision or a nasal endoscopic approach.
Summary
Seek immediate medical attention if
- Reduced vision
- Pain around your eyes
- A foreign body sensation
- Persistent watery eyes or eye swelling
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