Epiphora (watery eye)

What is a watery eye?

Most eyes are capable of watering when we are upset, for example or in a cold wind. A watery eye is one that is watering excessively and interfering with the patients normal activities.

What are the symptoms of a watery eye?

• Excessive tearing, especially indoors and when driving.
• Constant dabbing of the eyes.
• Sore excoriated skin under the eyes.

What is the cause of a watery eye?

There are either too many tears being produced, or the tear drainage pathway is not working properly or may be blocked.

Excessive tear production is linked to eye irritation, for example due to ingrowing eyelashes, blepharitis (eye lid inflammation), inadequate oil secretions and corneal ulcers.

If the lower eyelid is lax (sagging), or has an entropion or ectropion, the tears are not transported into the drainage system and may overflow onto the cheek.

The drainage system itself starts with a small plughole in the upper and lower eyelids close to the nose, continues to the tear sac and drains down a narrow passage into the nose. Any part of this pathway can be blocked.

What is the treatment for a watery eye?

A full eye examination is essential to work out the cause of the watering. The tear drainage duct can be syringed to determine if and where it is blocked. Sometimes an Xray is performed (DCG) which involves injecting a dye into the tear duct so that an Xray will show where the blockage is.

The treatment depends on the cause. Many causes of ocular irritation can be treated quickly and easily. Others such as blepharitis may take longer to treat.

If the tear ducts are blocked then surgery is required to unblock them. If the blockage is very close to the opening of the tear duct, then snipping open the top of the duct (one-snip operation) may be helpful. If the blockage is further down the tear ducts then a more major operation called a dacryocystorhinostomy is required. This involves bypassing the blockage by opening the tear sac directly into the nose. This can be done either under local anaesthetic with sedation or under general anaesthetic. A single nights stay in hospital is often recommended as there can be some post-operative nose bleeding.

Most patients experience immediate resolution of the problem once surgery is completed with little if any post-operative discomfort. Minor bruising may be expected and will likely resolve in one to two weeks following surgery.