Watery eye / Epiphora

What is a watery eye?

A watery eye, also known as epiphora, occurs when the eye produces excessive tears or when tears fail to drain properly through the tear ducts. This condition can disrupt the eye’s normal function, leading to constant tearing that may cause discomfort, blurred vision, and irritation. Common symptoms include persistent watery eyes, redness, and sometimes a feeling of heaviness around the eyes. Watery eyes can be caused by a variety of factors, including blockages in the tear drainage system, aging-related changes in the eyelids, infections, or inflammation. In some cases, anatomical issues like narrowing or obstruction of the tear ducts contribute to the problem. Treatment options depend on the cause and may include medications, procedures to open or clear blocked tear ducts, or surgical correction of anatomical abnormalities to restore proper tear drainage and improve comfort.

Symptoms

Symptoms of watery eyes, or epiphora, can vary depending on the cause but typically include excessive tearing that may overflow down the cheeks. This can be accompanied by redness, irritation, and a sensation of wetness or heaviness around the eyes. In some cases, the constant tearing can blur vision, particularly during activities such as reading or driving. Other symptoms might include crusting on the eyelids, discharge, or a sticky sensation if an infection is present. Some individuals experience increased sensitivity to light or wind, which can worsen the tearing. If the underlying cause involves a blocked tear duct or eyelid malposition, there may also be swelling or discomfort near the corner of the eye. Persistent or worsening symptoms should prompt an evaluation to identify the cause and determine the appropriate treatment.

Excessive tearing

Blurred vision

Double vision

Discharge

What causes Watery Eye?

Watery Eye Treatment

Treatment for watery eyes depends on the underlying cause, ranging from conservative management to surgical interventions. For mild cases, conservative approaches like using lubricating eye drops or ointments can help relieve symptoms, particularly for dry eye syndrome. If watery eyes are caused by eyelid inflammation, such as blepharitis, regular eyelid hygiene with warm compresses and cleaning routines can reduce irritation and improve tear drainage. For structural issues like entropion (inward-turning eyelid) or ectropion (outward-turning eyelid), surgical correction can reposition the eyelid, preventing further irritation and restoring normal tear flow. In cases of blocked tear ducts, a procedure called dacryocystorhinostomy (DCR) may be required to create a new pathway for tear drainage. These treatments are tailored to the underlying condition and are highly effective in resolving symptoms and improving eye comfort.

What are the management options?

Management options rely on the underlying causes. Below we will discuss the relevant treatment option tailored to each individual cause.

Blocked tear ducts

A blocked tear duct occurs when the pathway that drains tears from the eyes to the nose becomes partially or fully obstructed. This can lead to excessive tearing, discharge, redness, and sometimes swelling near the inner corner of the eye.

Symptoms

⦁ Excessive Tearing: Tears overflowing and running down the cheeks.
⦁ Swelling: Puffiness around the inner corner of the eye or near the tear duct.
⦁ Discharge: Sticky or mucus-like discharge, especially in the morning.
⦁ Redness: Mild redness in or around the affected eye.
⦁ Infection: Tenderness and warmth if the tear duct becomes infected.

Causes

A blocked tear duct occurs when the tear drainage system is partially or completely obstructed. Common causes include:
⦁ Age-related narrowing of the tear ducts.
⦁ Infections or inflammation in the tear drainage system (dacryocystitis).
⦁ Congenital blockages, where the tear duct fails to fully open at birth.
⦁ Trauma or injury to the nose or face affecting the tear ducts.
⦁ Nasal or sinus conditions, such as chronic sinusitis, that impact the drainage pathways.

Treatment

⦁ Warm Compresses: Applying a warm compress to the affected area several times a day can help reduce swelling and improve tear flow.
⦁ Massage: Gentle massage of the tear duct area can sometimes help clear mild blockages, especially in infants.
⦁ Antibiotics: If the tear duct becomes infected, your doctor may prescribe oral antibiotics or antibiotic eye drops.
⦁ Dacryocystorhinostomy (DCR): A surgical procedure to create a new tear drainage pathway to bypass the blockage.

Prevention

⦁ Eye Hygiene: Regularly cleaning the eyes and surrounding areas can help prevent blockages caused by debris or infection.
⦁ Avoid Rubbing Eyes: Keeping hands clean and avoiding rubbing the eyes can reduce irritation and the risk of introducing bacteria.
⦁ Treat Underlying Conditions: Managing sinus issues or chronic inflammation can help prevent tear duct blockages.

When to See a Doctor

Consult your healthcare provider if:
⦁ Symptoms persist or worsen despite home treatments.
⦁ There is significant redness, swelling, or pain.
⦁ Discharge becomes excessive or yellow/green, indicating possible infection.
⦁ Your vision is affected.

Follow-Up Care

Regular follow-up appointments may be necessary to monitor the condition and ensure the treatment is effective. For surgical procedures like DCR, additional visits will be scheduled to assess healing and functionality. Always adhere to the aftercare instructions provided by your healthcare provider.

Dry Eye

Paradoxically, dry eyes can cause excessive tearing as the eye tries to compensate for the dryness by overproducing tears.

Symptoms

⦁ Dryness: A feeling of dryness or grittiness in the eyes.
⦁ Redness: Persistent redness in the eyes.
⦁ Tearing: Paradoxical watery eyes as the body tries to compensate for dryness.
⦁ Burning Sensation: A stinging or burning feeling in the eyes.
⦁ Blurred Vision: Intermittent blurry vision, especially after prolonged use of screens or reading.
⦁ Eye Fatigue: Tired eyes, particularly after focusing for long periods.

Causes

Dry eye occurs when the eyes don’t produce enough tears or the quality of the tears is poor. Common causes include:
⦁ Aging: Tear production naturally declines with age.
⦁ Environment: Exposure to wind, smoke, or dry climates can exacerbate symptoms.
⦁ Screen Time: Prolonged use of screens can reduce blinking, worsening dryness.
⦁ Medications: Certain medications, such as antihistamines, diuretics, or antidepressants, can reduce tear production.
⦁ Medical Conditions: Autoimmune diseases like Sjögren’s syndrome, rheumatoid arthritis, or thyroid disorders can lead to chronic dry eye.
⦁ Eyelid Issues: Problems like incomplete closure of the eyelids can cause tear evaporation.

Treatment

⦁ Artificial Tears: Over-the-counter lubricating eye drops can provide immediate relief for mild cases.
⦁ Warm Compresses: Applying warm compresses can help open oil glands in the eyelids, improving tear quality.
⦁ Medicated Drops: Prescription eye drops like steroids can help reduce the inflammatory aspect of dry eye syndrome.
⦁ Punctal Plugs: Tiny plugs can be inserted into the tear ducts to prevent tears from draining too quickly, keeping the eyes moist.
⦁ Eyelid Hygiene: Regular cleaning of the eyelid margins can help manage associated conditions like blepharitis.
⦁ Lifestyle Adjustments: Using a humidifier, reducing screen time, and wearing protective glasses in windy environments can help prevent symptoms.

Prevention

⦁ Blink Regularly: Especially when using screens or reading for extended periods.
⦁ Protect Eyes: Use sunglasses in windy or dry conditions to reduce tear evaporation.
⦁ Stay Hydrated: Drinking enough water can support tear production.
⦁ Limit Irritants: Avoid smoking and exposure to smoke, dust, and other irritants.

When to See a Doctor

Consult an eye doctor if:
⦁ Symptoms persist despite using artificial tears or home remedies.
⦁ You experience severe pain, redness, or sudden changes in vision.
⦁ You suspect underlying conditions such as autoimmune diseases or eyelid abnormalities.

Follow-Up Care

Dry eye is often a chronic condition that requires ongoing management. Regular follow-up appointments may be necessary to monitor your symptoms and adjust treatment as needed. Your doctor may recommend additional therapies, such as tear gland stimulation or advanced procedures, if symptoms do not improve.

4 Tips to Improving Success

Achieve better outcomes with expert surgeons, advanced procedures, and a commitment to quality care. Our focus on precision, efficiency, and timely surgeries ensures your vision restoration is in trusted hands.

The Surgeon

The success of watery eye treatments depends on the expertise of your eye surgeon. I am a consultant eye surgeon with extensive experience in diagnosing and treating tear drainage issues, including surgical procedures. You can be confident that your treatment will be performed with precision and care to achieve the best possible results.

The Procedure

Treatments for watery eyes vary based on the underlying cause. For blocked tear ducts, a procedure such as dacryocystorhinostomy (DCR) is often performed to create a new drainage pathway for tears. If eyelid conditions like entropion or ectropion are contributing to the problem, surgical correction can reposition the eyelid and restore proper tear drainage. These procedures are typically safe, performed on an outpatient basis under local or general anaesthesia, and tailored to each patient's specific needs. I will guide you through the process, explaining every step to ensure your comfort and understanding.

Quality Surgery

Achieving the best outcome in a single procedure is crucial. As a Consultant Ophthalmic Surgeon with specialized expertise in watery eye treatments, I provide high-quality care that addresses both functional and aesthetic concerns. Whether the issue involves tear ducts or eyelid position, my approach is meticulous and patient-focused.

Prompt Treatment

Addressing watery eye symptoms promptly is essential to prevent discomfort, infections, or damage to the eye’s surface. From your initial consultation to treatment, I ensure a streamlined process, often scheduling necessary procedures within a short time frame to restore comfort and protect your eye health effectively.

FAQs About Watery Eye Treatment and DCR Surgery

What is DCR surgery?

⦁ Dacryocystorhinostomy (DCR) is a surgical procedure to create a new pathway for tears to drain from the eye into the nose. This bypasses a blockage in the tear duct system, relieving watery eye symptoms.

Who needs DCR surgery?

⦁ DCR surgery is recommended for individuals with a blocked tear duct causing persistent watery eyes, discharge, or recurrent infections that haven’t responded to conservative treatments.

How do I prepare for DCR surgery?

⦁ Before the procedure, your surgeon will provide specific instructions. You may need to stop certain medications, such as blood thinners (e.g., aspirin, warfarin, or clopidogrel), a few days before surgery to reduce the risk of bleeding. Always consult your doctor before making any changes to your medication.

Will I need any tests before DCR surgery?

⦁ No, these are not routinely required. However, in some cases your surgeon may order scans such as a CT scan or dacryocystography, to confirm the location of the blockage and evaluate the tear drainage system.

What happens during DCR surgery?

⦁ DCR surgery can be performed externally (with a small incision near the nose) or endoscopically (through the nasal passage). The surgeon creates a new drainage pathway for tears and may place a small stent in the duct to keep it open during healing.

Is DCR surgery painful?

Once you understand the risks and benefits and decide to proceed, you’ll sign a consent form and receive information leaflets. We⦁ The surgery is performed under local or general anaesthesia, so you won’t feel pain during the procedure. Mild discomfort or swelling is common afterward, but it’s usually well-managed with painkillers. ’ll then add you to the waiting list for surgery. Remember, you can change your mind about the surgery at any time before it happens. Before the surgery date, we’ll invite you for a pre-operative visit to take measurements of your eye (called Biometry) and check your overall health suitability. If there are issues like uncontrolled blood pressure or diabetes, we might delay putting you on the list until these are managed better.

How long does the surgery take?

⦁ DCR surgery typically takes about 60-90 minutes, depending on the technique used and the complexity of the case.

What can I expect after the surgery?

⦁ After surgery, you may experience mild swelling, bruising, or a small amount of bleeding from the nose. Most patients notice significant improvement in tearing within a few weeks.

How do I care for myself after DCR surgery?

⦁ Use any prescribed eye drops or nasal sprays to prevent infection and promote healing. Avoid blowing your nose for at least two weeks, and sleep with your head elevated to reduce swelling.

What activities should I avoid after DCR surgery?

⦁ Avoid strenuous activities, heavy lifting, or bending over for about two weeks. Do not swim or use saunas until your surgeon clears you to do so.

When can I return to work after DCR surgery?

⦁ Most patients can return to light work within a week, but this depends on the nature of your job and your recovery progress. Discuss your specific timeline with your surgeon.

How long will the stent stay in place?

⦁ If a stent is placed during the surgery, it typically remains for 2–3 months to ensure proper healing. Your surgeon will remove it during a follow-up visit.

What are the risks of DCR surgery?

⦁ DCR surgery is generally very safe, but potential risks include infection, bleeding, scarring, or re-blockage of the tear duct. Your surgeon will discuss these in detail before the procedure.

Can I wear my glasses after DCR surgery?

⦁ Yes, you can usually wear your glasses immediately after surgery. However, avoid wearing contact lenses until your surgeon advises it’s safe to do so.

When should I call my doctor after surgery?

⦁ Contact your surgeon if you experience severe pain, excessive bleeding, sudden vision changes, or signs of infection, such as increased redness, swelling, or discharge. These may indicate a complication requiring immediate attention.

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