Epifora: why tearing or watery eyes occurs

Written by: Dra. María Teresa Sellarès Fabrés
Published: | Updated: 15/11/2018
Edited by: Top Doctors®

For many people crying is not synonymous with having some psychic or physical pain, it is simply something everyday, sometimes even crippling for your daily activity. This is because the volume of tears produced is greater than that which can be eliminated by the normal route of excretion.

Why the tear line is blocked and watery eyes

A healthy person produces tears to feed and repair the surface of the eye, and these are eliminated through the lacrimal route, which begins at the lacrimal points located in the inner third of the eyelids. From there the tear runs through the lacrimal canaliculi to the lacrimal sac and from it goes to the nose through the nasolagrimal canal. However, this circuit may become clogged. In the adult the most frequent is that it occurs at the level of the union between the lacrimal sac and the nasolacrimal duct and, in the baby, at the point of drainage of the nasolagrimal canal into the nasal cavity.

Some patients, due to different pathological processes like ocular allergies, corneal wounds or other health problems, produce an excessive amount of tears that can not be eliminated by the lacrimal route, presenting a more or less constant tearing. It will be the detailed ocular exploration that will allow the specialist in Ophthalmology to identify this excess in the production of tears and to guide the necessary treatment.

Other patients have a totally correct or even diminished tear production with total or partial obstruction of the drainage path. These patients present a more or less invalidating epiphora, depending on the degree of obstruction and the amount of tear produced. It is these patients who can benefit from surgery that reopens the tear.

Causes of epiphora or watery eyes

Causes of obstruction of the lacrimal pathway are poorly understood. It is known to be more frequent in women over 40 years of age and, therefore, hormonal problems and problems due to makeup have been postulated, but it has not been possible to demonstrate a clear relationship between these factors and the epiphora. As we have said, the treatment for these cases is surgery.

Surgical treatment of epiphora

Epiphora surgery is performed with a laser. This technique is based on the creation of a communication between the lacrimal sac and the patient's nasal cavity. This communication is done through the existing tear duct, thus avoiding the unsightly scars that occur when performing classic surgery. This technique allows to perform the intervention under local anesthesia, without sutures and with a fast recovery of the patient.

There are other techniques to repair the epiphora, although they all rely on re-connecting the tear line with the nose. They are surgeries that are performed in the external or classic way by ophthalmologists, and that need a more or less wide wound to reach the nose bone, which must be drilled to get a new drainage. In the internal pathway, used by otolaryngologists, external injury is avoided, but general anesthesia is required because of the maneuvers that have to be performed inside the nostril in order to pierce the nose bone.

Epiphora in newborns

A special case of epiphora is the one that occurs in newborns, more common in premature babies. Many of these cases resolve spontaneously in the first months of life, but in some of them it is necessary to perform surgical maneuvers to achieve the correct drainage function of the tear.

The first maneuver to open the tear line is the catheter. This solves more than 95% of the cases. And, in cases of failure, this maneuver can be repeated up to three times, increasing the number of successes. In the most refractory cases, drainage tubes are placed during variable periods of time and, if these maneuvers also fail, the surgical techniques described for adults should be performed.

*Translated with Google translator. We apologize for any imperfection

By Dra. María Teresa Sellarès Fabrés

Dr. Sellares Fabrés is a renowned specialist in ophthalmology. He has combined his career with teaching, serving as associate professor of Ophthalmology at the Autonomous University of Barcelona.

*Translated with Google translator. We apologize for any imperfection

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