Guide to Understanding Watery Eyes: Symptoms, Causes, and Treatment Options

“My eyes are tearing, it drives me mad as people think I am crying and keep asking me what´s wrong”. So often, patients come to Clinica London bemoaning their tearing eyes. We can help with your watery eyes treatment. Read on to find out how.

Tearing, Watery Eyes and Epiphora

Watery eyes and tearing are also known as epiphora. Watery Eyes is a bothersome condition that affects many adult individuals as well as children. It occurs when excess reactive tears are produced or when the tears do not drain properly through the lacrimal outflow system.

In this blog we explore the symptoms, causes, and various treatment options available for adult patients with watering eyes, to help you understand and manage this condition more effectively.

Symptoms of Watery Eyes

The primary symptom is excessive tearing. However, several other accompanying signs may indicate the presence of epiphora, including:

1. Lacrimation or wet feeling eyes.
2. Blurred vision or temporary vision disturbances.
3. Eye irritation or redness.
4. Sensitivity to light.
5. Mucus discharge from the eyes.
6. Eye fatigue or discomfort.
7. Crusting of the eyelashes, particularly upon waking up.
8. Watering eyes all the time, worse outside.

Causes of Watery Eyes

Watery eyes can arise from various underlying causes, including local eye and eyelid causes and actual blocked lacrimal outflow:

1. Allergies: Seasonal allergies or allergic reactions to irritants such as pollen, dust mites, or pet dander can trigger excessive tearing.
2. Dry Eye Syndrome: Paradoxically, dry eyes can lead to watery eyes as the tear glands produce more tears in response to the dryness, resulting in an overflow.
3. Conjunctivitis: Commonly known as pink eye, conjunctivitis is an inflammation of the conjunctiva, which can cause watery eyes along with other symptoms like redness and itching.
4. Eye Irritants: Foreign bodies, irritants, or chemical exposure can stimulate excessive tear production as a protective mechanism.
5. Eye Infections: Infections such as blepharitis (eyelid inflammation) or keratitis (cornea inflammation) can cause watery eyes as part of their symptomatology.
6. Blocked Tear Ducts: Blockages or obstructions in the lacrimal outflow system or tear drainage ducts can prevent tears from properly draining, leading to watery eyes.

Treatment Options for Watery Eyes

The treatment of watery eyes depends on the underlying cause. Here are some common approaches:

1. Artificial Tears: Over-the-counter lubricating eye drops or artificial tears can help alleviate dryness and reduce excessive tearing caused by dry eyes.
2. Allergy Medications: Antihistamines or allergy eye drops can be used to manage watery eyes caused by allergies.
3. Warm Compresses: Applying warm compresses to the eyes can help relieve blockages in the tear ducts and improve tear drainage.
4. Eye Drops for Infections: If an eye infection is the root cause, your doctor may prescribe antibiotic or antiviral eye drops to treat the underlying infection.
5. Eyelid Hygiene: Practising good eyelid hygiene, including regular cleansing and warm compresses, can help manage conditions like blepharitis, reducing excessive tearing.
6. Tear duct (lacrimal) Surgery: In cases where the lacrimal outflow system has a tear duct blockage, surgical intervention is the treatment required to open or bypass the blocked ducts, allowing proper drainage and relieving watering eyes.

This treatment is called dacryocystorhinostomy of DCR for short. This surgery is done through the nose to reach the lacrimal sac and open it up to help the tears drain normally again.

“Through the Nose” DCR Treatment for Watering Eyes

Endoscopic Endonasal Dacryocystorhinostomy (DCR)

Endoscopic endonasal DCR is recommended for patients who present with symptoms of chronic tearing (epiphora) or recurrent lacrimal sac infection and swelling due to lacrimal duct obstruction. When the sac is swollen it is called a mucocoele or can even be infected as a chronic or acute painful dacryocystitis. The patient then has both watering eyes and mucous discharge. DCR is indicated where the lacrimal outflow blockage is located at the level of the nasolacrimal duct or the lower lacrimal sac.

The assessment includes excluding all other causes of epiphora and establishing that there is a blocked tear duct causing the epiphora, by first doing out-patient full assessment with syringing and probing, nasal endoscopy and occasionally additional radiological tests.

Endoscopic endonasal dacryocystorhinostomy (DCR) is a minimally invasive surgical procedure to overcome nasolacrimal duct obstruction. The surgery aims to restore the normal flow of tears from the eye into the nasal cavity (you are likely not aware that is where the tears go). By accessing the lacrimal sac through the nose, the oculoplastic lacrimal surgeon is able to drain any mucocoele or dacryocystitis and hence bypass the blocked tear drainage pathway, allowing tears to drain properly. Then the watery eye and discharge is cured. It is an operation with a 95% success rate.

Procedure:

1. Anaesthesia: The procedure is typically performed under general anaesthesia or local anaesthesia with sedation, depending on the patient’s preference and the surgeon’s recommendation.
2. Patient positioning: The patient is placed in a supine position with the head slightly tilted back. The surgeon may use a headrest or padding to ensure proper alignment.
3. Nasal endoscopy: A nasal endoscope is inserted into one nostril to visualize the nasal cavity and access the lacrimal sac.
4. Fantastic visualisation of the surgical area within the nose is achieved using the FESS video stack and fine intranasal FESS instruments used ensuring accuracy and precision surgery.
5. Opening osteotomy: The lacrimal surgeon creates a small bony opening in the lateral wall of the nasal cavity near the lacrimal sac. This drainage hole drains tears anew from the sac into the nose.
6. Silicone tubes: Optionally the surgeon inserts a thin, flexible tube called a lacrimal silicone tube which you are unaware of. It is often left in place for a few weeks to ensure proper healing and maintain patency.
7. Post-operative care: After the procedure, the patient is usually observed for a short period in the recovery room.
8. Antibiotic and nasal saline rinses are prescribed to prevent infection and promote healing. If a silicone tube has been placed, it is easily and simply removed at a follow-up visit.

Benefits of Endo DCR treatment for watering eyes:

• Minimally invasive: The endonasal approach eliminates the need for external incisions, resulting in reduced scarring and faster recovery.
• Improved cosmetic outcomes: The procedure is performed entirely through the nostrils, leaving no visible scars on the face.
• High success rate: Endoscopic endonasal lacrimal DCR has shown favourable outcomes in most patients, providing long-lasting relief from symptoms 95% success.

Endoscopic endonasal DCR is a valuable surgical procedure for the treatment of nasolacrimal duct obstruction causing watering eyes. By providing an alternative drainage pathway for tears, it effectively relieves symptoms of epiphora and discharge and improves the patient’s quality of life.

Here are some interesting facts about watery eyes:

1. Tear production: On average, a person produces about 10 ounces (300 millilitres) of tears per day. Watery eyes occur when there is an excess production of tears or when tears are not draining properly.
2. Emotional tears vs. reflex tears: There are three types of tears: basal tears, which keep the eyes lubricated; reflex tears, which occur in response to irritants like onion fumes or smoke; and emotional tears, which are shed during moments of intense emotions such as joy, sadness, or stress.
3. Tear composition: Tears are not just made up of water; they also contain oils, mucus, antibodies, and enzymes that help protect the eyes from infection.
4. Tear duct system: Tears are produced by the lacrimal glands located above the outer corner of each eye and by other lacrimal tissue on the surface of the eye. The tears spread across the surface of the eye and drain into the tear ducts, which lead to the back of the nose and throat.
5. Environmental factors: Wind, smoke, air pollution, and dry air can all contribute to watery eyes by irritating the eyes and triggering excessive tear production.
6. Underlying eye conditions: Watery eyes can be a symptom of underlying eye conditions such as dry eye syndrome, conjunctivitis (pink eye), blepharitis (eyelid inflammation), or keratitis (cornea inflammation).
7. Age-related changes: As we age, our tear production decreases, leading to a higher risk of dry eyes. Paradoxically, this can sometimes cause watery eyes, as the eyes compensate for the dryness by producing more tears.
8. Allergies and watery eyes: Allergic reactions, such as hay fever or seasonal allergies, can cause watery eyes. When allergens come into contact with the eyes, the immune system responds by releasing histamines, leading to excessive tearing.
9. Tear duct blockages: Blocked lacrimal outflow system or the nasolacrimal duct prevents your tears from draining properly, resulting in watery eyes. This condition is common in adults due to infections, injuries, or age-related changes.
10. Treatment options: Treatment for watery eyes depends on the underlying cause. It can range from using artificial tears and warm compresses to manage dry eyes, to medications for allergies or infections, and in some cases, surgical intervention with DCR to address tear duct blockages.

If you experience persistent or severe watery eyes, it is always advisable to consult with an oculoplastic lacrimal ophthalmologist for a proper diagnosis and treatment plan.

Conclusion

Watery eyes can be a frustrating and embarrassing condition, but with proper understanding and treatment, its impact can be minimised. If you experience persistent or severe watery eyes, it is advisable to consult an oculoplastic lacrimal ophthalmologist who can diagnose the underlying cause and recommend an appropriate treatment plan, which may include EndoDCR surgery. Remember, individual cases may vary, and the information provided here serves as a general guide.