What is Tearing in Adults?
There are many causes of watery eyes in adults and a useful way to summarise the main potential problems is as follows:
- Conditions which cause increased tear production
Anything which irritates the eye surface can lead to excess tears being made e.g. in growing eyelash, foreign body under upper lid, eyelid margin lump. Tear production is also often increased in blepharitis, allergy or infection.
- Eyelid Abnormalities
The tears travel along the lower eyelid until they reach in the inner corner of the eye and exit through the upper and lower drainage holes (puncti). A lax eyelid it may fall away from the eye surface such that the lower punctum is no longer in contact with the globe and therefore cannot be accessed by the tears. The treatment for watering under these circumstances is an eyelid operation to correct the malposition.
- Conditions which reduce tear drainage
Commonly watery eyes are due to reduced tears draining away from the eye into the nose. One of the easier causes to treat is a narrowing of the drainage holes – “punctal stenosis”. These plug holes can often be widened using perforated punctal plugs which are usually inserted under anaesthetic drops. They are left in for a few months to stretch the drainage opening and are easy to remove in the out-patients.
Many people with watery eyes will have a narrowing or blockage further down-stream in the lacrimal system, most commonly at the lower end of the tube (naso-lacrimal duct) before it enters the nose. If present the best option to alleviate watering involves a larger operation to create a new artificial tear duct channel into the nose – such a procedure is called a Dacryocystorhinostomy (DCR).
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