Watery Eyes

Watery eyes are a very common problem in people of all ages and genders. The eyes can be watered in windy weather, in excessive sun exposure, dusty soil environments, or while chopping onions, but in some people, this problem may occur more intensely and often than usual, although there is no apparent reason. The medical naming of these overly watered and flowing eyes is “epiphora”.

A few major factors that may cause this problem are a blockage in the tear ducts, that is, the tear-draining system that is used and must be discarded, a malfunction of the eyelids working like a pump, and even an over-drying eye. We must understand the tear discharge system so that we can deal with these issues one by one first of all. 

Normal Tear Flow

Normal tears are secreted in the eyelids and by the tear glands in the bone hole where the eyes, called the orbit, rest in. This secretion is distributed on the surface of the eye with blinking and provides the oxygen and nutrient support that the eye needs, and also cleans the eye surface. In this way, healthy and sufficient tear secretion is significant for healthy eyes. The discharging of the tear utilized is as important as a suitable and adequate secretion. Discharging is mainly done by pumping the used-waste-tear through the blinking motion towards the tear discharge system. Eyelids push the utilized tear into the discharge ducts, which should be discarded by closing from outward to inward like a zipper in very short time  These ducts are two as being one in the upper lid where the eyelids joint at the edge of the nose and the other in the lower part. It starts with a micro-opening called punctum, which is located on the free edge of the lids, proceeds as a canal under the skin along with the ligaments where the eyelid is attached to the nasal bone and collects in the pouch called "tear sac" at the edge of the nose. After this pouch, it flows through the nasal posterior cavity into the nasal cavity. This waste tear also contributes to the moistening of the intranasal structures. If, for any reason, a blockage occurs in this discharge system or the pump mechanism does not work properly, the tear that will be discharged will accumulate in the eye first before it is discharged. This is a condition that significantly impairs quality of life and should be treated in most cases.

What are the main causes of Watering in the Eyes?

The main causes of epiphora;

  • A blockage in the tear discharge system
  • Failure in the pump mechanism operating with a blink to direct the waste tear to the discharge system
  • Chronic dry eyes or conditions that cause chronic irritation on the eye surface.

Blockage In the Tear Discharge System

A blockage is one of the most common causes of the tear discharge system. Blockage at any distance on the discharge system prevents discharge despite the presence of healthy eyelids that perform normal pumping function. In this situation, both the waste that is normally used and excessive tears that are unusable begin to accumulate on the surface of the eye, accumulate in the lower lid and eventually flow out of the lid edges. The accumulation of waste tear inside prevents vision, disturbs the eye, causes redness and stinging, and makes the eye open to infections and causes recurrent chronic infections on the surface of the eye. Actually, this distorted tear that often flows through the edges of the eyelid can irritate the delicate skin around the eyelid, causing redness, itching, skin structure deterioration, and even local infections. When patients have to wipe this constantly flowing tear out, eyelid anatomy may also be disrupted and eyelid deformities that require operation may occur from time to time. The location and level of blockage are the most important problems that need to be focused and solved at this point. Canal blockage can occur at any age, including neonates (approximately 1/20 of the newborn).

Duct blockage in newborns actually occurs due to the fact that several microvalves at the lowest part of the tear sac opening into the nasal cavity are not fully opened. In this case, families often notice the problem very early. From the first months, there is constant watering and running in one or sometimes both eyes of the baby. Occasionally, infections appear on the surface of the eye due to congestion and waste tear. It can usually be diagnosed by pediatricians during a well-child examination. In this case, massage is the most important treatment option for the area where the tear sac is located at the edge of the nose until the baby reaches the 11-12 month period. If the pressure inside the pouch can be increased with an effective massage application, the lids that are not fully opened at birth can be opened and the problem is solved. During periods of infection, watering will also be accompanied by burrs, redness, and swelling, and the baby will be restless. These discharge and burrs accumulated in the eyes during the infection periods should be cleaned with soft cloths moistened with warm water or a piece of cotton and treatment with antibiotic drops should be applied under the supervision of an ophthalmologist. Despite massage and cleaning, the procedure called probing is applied in the ducts that are still not open around the age of 1. In this process, under mild anesthesia, tear ducts are expanded with special equipment and clogged lids are opened by advancing along the ducts with very thin probes. Once the system starts running, there is no major problem again. In rare cases, when the probing process fails, micro silicone tubes or stents can be placed for a while to prevent the openings formed during the procedure from closing.

The location and level of the obstruction is important in duct obstructions seen in older ages. Micro openings called punctum can be closed frequently at the duct entrances, and their expansion in the office environment, micro silicon plugs to maintain the opening, or in small cases, small surgical procedures to be made to punctum in advanced situations usually correct the problem.

Infection in the sac lobe, abscess, and excessive inflammation of the eyes and progression of the infection on the eye surface can be seen in more severe obstructions of a deeper level. In the case of delaying the treatment, the area of infection may enlarge, causing abscesses, fistula formation under the skin, and even through the orbital septum, causing threatening conditions such as orbital cellulitis. Treatment is to repair blocked areas with surgical intervention without delay and to establish a working discharge system in such cases. The operation generally gives good results and to a large extent, the discharge system operates healthy without being blocked for many years.

In addition to all of the above-mentioned situations, nose problems may cause watery eyes. Polyps that cover this area, tumors, sinus disorders or structural disorders in the nose may be the cause of epiphora since the discharge system opens into the nose. In such cases, cause-oriented therapy will yield results.

Pump Mechanism

One of the most common reasons is what we call the pump mechanism is that the eyelids are insufficient to discharge used tears with blinking although the discharge system is working well and healthy. Normally the eyelids close like a zipper from the outside to the inside, ie from the ear to the nose, and it directs the waste tear to the discharge ducts, but some problems in this mechanism may cause the tear to be gathered in the eye and flow out, even if there is no blockage in the discharge system.

Structural changes (congenital or subsequent) in the eyelids can eliminate an effective blink and effective pump. In these cases, surgical interventions are usually planned to correct the eyelid function for treatment. With the increase of age, loosening of the eyelids may cause the outer parts of the lower eyelids to sag. In such cases, it is also possible to improve the pump function with small surgical interventions that can be performed under local anesthesia.

The pump function is weakened because the muscles that close the eyelids are also affected in facial paralysis due to any reason such as bell paralysis or acoustic neurinoma. This again affects the evacuation of tears and causes watering. Treatment is to correct the eyelid function as much as possible with minor surgical procedures for the underlying condition.  

Does Thyroid Disease Cause Watery Eyes?

The thyroid is one of the most common problems in society. In some of the thyroid patients, the eyes are also affected. Although there are dry eye complaints in general due to the deterioration of tear quality and decrease in the number of thyroid patients, disruptions in tear discharge may result in watering in cases where the function of the eyes and lids deteriorates structurally. Treatment in these patients should be based mainly on the stage of thyroid disease.

Dry Eye

Although this is confusing, dry eye is one of the most common conditions that cause excessive watering in the eyes. Over time, dry eyes occur as a chronic problem with the decrease in the number of tears and deterioration in quality, especially in those living in dry climates. In these patients, a continuous watering, which is stood out by redness, stinging and burning in the eyes, causes the tear glands to come into play and watering. In such cases, if there is no other underlying systemic disease causing dryness, treatment is to relieve the patient with teardrops. Surgical interventions are generally not required. 

From time to time, patients may experience dry eye and subsequent reflex over-watering after trauma or eyelid or orbital surgeries. In such cases, a careful eye contour and eyelid examination will often reveal eyelid deformities that occur after surgery or trauma. The treatment is to correct the deformities that occur with a new surgery. Especially in aesthetic eyelid surgeries, which have been applied frequently in recent times, paying the utmost attention to the protection of eyelid functions and protecting the muscles that open and close the eyelid will eliminate the situations that may occur such as,  being left open, incapability to fully close, impaired pump function and dry eyes and reflex. tearing

In addition, watering due to irritation occurs in floppy eyelid syndrome, which is encountered in some patients with sleep apnea. As these patients usually sleep in a face-down position, the upper eyelids turn during sleep due to the looseness in the eyelids and come into contact with the pillow surface. People encounter red, painful, watery eyes when they wake up in the morning due to the lids that remain partially open until the morning and rotate outward and touch the around. Although CPAP machines and artificial tear drops and ointments provide relief in some patients, in some cases, eyelids should be shortened and tightened by surgical intervention. 

Treatment of Watering in Eyes

As we have briefly explained above, the main approach to watery eyes is diagnosing the cause correctly. Therefore detailed eye and eye area examination are crucial. In some cases, the ophthalmologist makes the diagnosis, but for a more detailed examination and evaluation of treatment options, it may be a better option to refer an oculoplastic surgeon like Dr. Solmaz. A physician who is specialized in this field can determine the situation causing watering more clearly with a more detailed examination. A number of methods that can be applied in the examination environment such as controlling the tear pathways with lavage and/or dry eye tests and not disturbing the patient are very important in determining the correct treatment.

Surgery for Epiphora

There are different surgical options related to watery eyes problem. The main issue here is to make the diagnosis correctly and to eliminate the factor. In patients with tear duct obstruction, different surgical applications can be preferred depending on the level and severity of the obstruction under local or general anesthesia. Tightening the eyelids surgically can also treat watering complaints in pump function disorders.

Can Eyelid Surgery Treat Irrigation?

Eyelid surgery is one of the methods that Alexander uses frequently in patients suffering from watery eyes. Especially in patients with pump function failure, tightening of the lids simultaneously with eyelid aesthetics can also eliminate the complaint of watering. Again, the treatment that will be selected in patients with chronic dry eye and reflex tearing, in which the eyelid function or shape related to previous eyelid operations have changed, is restoring the eyelid shape and functions to normal as much as possible with additional surgeries.  Patients who are discharged on the same day after the operation usually return to their daily lives in a week or 10 days. There is no significant pain in the healing process, but swelling, bruising and mild itching may occur. Usually, ice application and drop ointment treatment is sufficient for the postoperative period.

Tear Duct Surgeries

Local anesthesia or general anesthesia is preferred under sedation in surgeries performed in deep duct obstructions. Patients are discharged from the hospital on the same day. There may be mild pain, slight itching, swelling, bruising, and redness at the seams in the first days following the surgery. Patients return to their normal lives by the removal of stitches within one week-10 days. Since the sutures and methods used are in accordance with the principles of aesthetic surgery, there is little or no indeterminate incision scars or none at all. Quite rarely, during the operation, silicone tubes can be placed to be removed within 4-6 months. In some patients, if appropriate, procedures can only be performed by tube insertion (without incision). The success of the operation is quite high in percentage and the probability of the recurrence after the successful operation is almost nonexistent. Surgically, the most commonly applied method is DSR (DakrioSistoRhinostomy), which is the gold standard worldwide.


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