Eyes that water too much are a very common concern for people of all ages. Excess tears normally occur in the wind, while chopping onions, and of course at a sad movie. But many people experience extra tearing much more frequently and without any obvious inciting cause – why is this?
There are several answers to this question, including blocked drainage of tears through the normal passageways, failure of the normal blinking pump, and even excessive eye dryness that sometimes stimulates extra tearing. We’ll cover each of these after a quick review of the normal way that tears flow. The medical term for excess tears is epiphora.
Normal Tear Flow
Normally, glands in the eye socket and eyelids make tears, which are then spread around by blinking to keep the eye always moist. Blinking pushes the tears inward toward the nose. Hidden in the inner corner of the upper and lower eyelids are a pair of drainage holes that connect to the nose with a set of tiny ducts. Thus, some tears normally flow into the nose with every blink, helping to keep the nose moist.
What Causes Watery Eyes?
Epiphora can result from a number of different causes. These include:
Blocked Tear Duct
The first thing that can go wrong is that the flow of tears from the eye to the nose gets blocked. The tears then have nowhere to go and they pool at the eye and run down the face. This can happen because the drainage holes close or because the ducts get blocked along the way to the nose. It can even happen in newborn babies when the final process of opening the ducts doesn’t occur on time (this affects about 1 in 20 newborns). Depending on when and where the blockage occurs, the treatment to solve the problem may be different.
For infants with tearing and mucus, pediatricians will often recommend gentle massage at the inner corner of the eye to push the tears along and hopefully open the passage into the nose. If that doesn’t work by the first birthday, then an eye surgeon can pass a fine probe through the duct under anesthesia and usually solve the problem. Sometimes a temporary soft silicone plastic stent can be inserted to help as well.
For older children and adults with a closed tear drainage hole (the medical term is punctum), a minor surgery office procedure is often enough to open it and restore normal flow.
For older children and adults with blocked tear ducts deeper inside, things are bit more complicated. Some of these people may have chronic or acute infections that cause redness, pus, or swelling in the inner corner of the eye, but many do not and only experience excess tears.
Outpatient day surgery is often necessary to restore tear flow through the normal channels or to bypass the blockage and deliver the tears to the nose, often with the placement of a temporary soft silicone plastic stent. The most commonly performed surgery is called DCR (for DacryoCystoRhinostomy). Dr. Fante is the co-author of the largest published series of DCR surgeries in America.
Nasal problem can also cause tearing since the normal tear duct drains into the nose. Polyps, tumors, sinus disease, and structural abnormalities in the nose can each contribute to excess tears. Depending on the actual problem, medication or outpatient surgery can be helpful.
The second thing that can go wrong is that, even though the drain is open, blinking fails to push the tears toward the inner corner. For these people, the problem is typically solved with outpatient day surgery to repair the integrity of the eyelids.
Age tends to loosen the tendons that keep the eyelids tautly snug against the eyeball. Often this permits the lower eyelid to drop down lower than normal and the tears pool at the lowest point, ready to drip down the cheek. The tendon at the outer corner can be tightened as outpatient day surgery, typically resolving the problem.
Any cause of facial paralysis, from Bell’s palsy to acoustic neuroma, can also reduce the efficiency of blinking, and create excess tearing. Again outpatient day surgery to improve eyelid closure and tension can help to solve the tearing problem.
Thyroid Eye Disease can cause the eyelids to widen and often reduces blinking. It can also cause swelling and irritation behind the eye and on the surface of the eye itself. All of this contributes to excess tearing. The proper treatment depends on the phase of the disease. See link to TED page.
This is counterintuitive. The third thing that causes excess tearing is chronic dryness or irritation of the eyes. Most people’s eyes become gradually drier as they age. This may not be an issue in humid climates, but in the arid West it is a huge problem. There are millions of dry eye sufferers in Colorado and the surrounding states, and the problem is even worse at high altitudes in the Rocky Mountains. Although the eyes may be chronically dry and irritated, they will still occasionally tear excessively when the body tries to reflexively wet them, sometimes misleading the person to think that the problem is wetness instead of dryness.
For people with dry eye syndrome, an eye specialist will usually prescribe artificial tears, and sometimes a series of other treatments that can help improve the quality and quantity of tears. See our summary. Outpatient eyelid surgery is not usually needed, but can help certain people.
A similar cycle of dryness and wetness can happen to people after trauma or surgery near the eyes, especially after certain kinds of facial fracture repairs or cosmetic surgery under the eyes. Examination by a specialist will often disclose scarring of the lower eyelid that restricts proper blinking. Outpatient reconstructive surgery to restore eyelid position and movement will often help to resolve the problem.
Some people with sleep apnea develop a condition known as floppy eyelid syndrome that can affect the upper and lower eyelids. Since they often sleep face down, their floppy eyelids can flip inside out at night, exposing their eyes to the air and pillow. As a consequence they often notice redness, irritation, and tearing in the mornings. CPAP machines and eye ointments may help, but for some people, outpatient eyelid surgery may be needed.
How to Stop Watery Eyes
It is clear from the summary above that the treatment for excess tearing varies substantially depending on the cause. Evaluation by your optometrist or ophthalmologist may be sufficient to identify your problem and to start treatment, but you might be referred to an oculofacial plastic surgery specialist, such as Dr. Fante, for a more comprehensive evaluation. A specialist will examine the eyelids and surface of the eye, and will also usually probe and irrigate the tear ducts, and examine the nose to find all possible causes for excess tearing. For adults these tests can be easily accomplished in the office with minimal discomfort. However, for babies and small children, an evaluation (together with treatment) will be recommended under anesthesia.
Surgery for Epiphora
As highlighted above, there are several different outpatient procedures used to solve the various different problems that cause excessive tearing. Depending on the patient and procedure, these are usually performed with conscious sedation or general anesthesia in an ambulatory surgery center or hospital.
For the eyelid surgeries, there is usually minimal pain but some swelling, bruising, and stitches are common. Most people can return to work or everyday life about a week after surgery.
For the tear duct surgeries, there is also usually minimal pain. Many of these are accomplished using a nasal endoscope, and afterward, there is no swelling or bruising, but there is often a bloody nose for a few hours. People are able to return to work or everyday life within a few days. Other kinds of tear duct surgery are performed in the inner corner of the eye itself, and then there is often temporary swelling, bruising, and stitches that may delay return to work until a week after surgery.
Schedule a consultation
If you are interested in treatment for tearing problems, contact our Denver office today! Call (303) 839-1616 to schedule a consultation with facial plastic surgeon Dr. Robert Fante.