According to a study in the American Journal of Ophthalmology, approximately 16 million people in the United States have been diagnosed with dry eye disease. The same study, though, estimates that about 33% of ophthalmology patients present with the symptoms of this condition. One of the most prevalent symptoms of dry eye disease is excessive tearing. Because it is such a common symptom, people who experience excessive tearing often believe, after a quick online search, that they have dry eye disease. This may not be the case. Here, we discuss some of the other reasons excessive tearing may occur and what you can do to improve this symptom.
Normal Tear Flow
The tear film is a vital part of the healthy eye. This film, made of oil, mucus, and water, is made in glands in the eye socket. When we blink, this film is spread over the ocular surface in the direction of the nose. There, at the inner corners of the upper and lower eyelids, are tiny drainage ducts that connect to the nose. Some tears naturally flow into the nose, then, when we blink. Some of the tear film also evaporates from the ocular surface. We all get dry eyes and excessive tearing from time to time, but when the condition is the norm, we want to know why. True understanding comes from looking beyond dry eye symptoms.
Conditions that Could Cause Excessive Tearing
Blocked Tear Drainage Ducts
Remember we mentioned that tears flow toward the center of the eyes to tiny ducts that connect to the nose. One or both of these ducts could become blocked, preventing tears from draining normally into the nose. Common sources of tear duct blockage are infection, inflammation, certain medications, injury, previous sinus surgery, or, rarely, a tumor. Blockages in tear ducts can be partial or complete, and may result in not only watery eyes but also inflammation, irritation, and an increased risk of infection.
Once tears enter the ocular area, the muscles in the eyelids move the film toward the natural ductal system. Certain conditions affecting the eyelids may diminish this function. Ectropion is characterized by an outward turn of the lower eyelid. It is usually seen in older people and relates to the natural weakening of the tendons and muscles that control the lower eyelid and hold it against the globe of the eye (eyeball). Ectropion may also occur as a symptom of Bell’s palsy or other facial paralysis. Because the lower eyelid does not sit against the globe as it should, the glands that produce the tear film are triggered to reflex tearing to keep the eye lubricated.
Loose eyelids do not always indicate ectropion. Some people develop extremely loose upper eyelids. Without sufficient firmness and strength, the eyelids open when the person sleeps. Symptoms of this condition, referred to as Floppy Eyelid Syndrome, may include waking up with scratchy, watery eyes. People with sleep apnea often experience this condition.
Evaluation by your optometrist or ophthalmologist may be a good place to start uncovering the cause of excessive tearing. However, you may benefit most from a consultation with an oculofacial plastic surgery specialist, such as Dr. Fante or Dr. Goecks. Here, patients can expect a comprehensive evaluation of the eyes and eyelids to determine the cause of watery eyes.