Spontaneous Eye Tearing: Excessive Tears &
Excess tearing can be due to a
large number of different eye problems, both simple and complex.
It is a very common complaint of patients and in complicated
cases, it may take several visits and require several attempts
at different remedies before the symptoms are satisfactorily
Epiphora is the
medical term used when the excess tears spill over the eyelid
and run down the face. Usually excessive tearing can be
controlled medically but sometimes, it may be necessary to treat
surgically. Fortunately, in these cases, there is a high degree
of success and of patient satisfaction.
Dry Eye Syndrome
One of the most common causes of excess tearing
in older adults is dry eye syndrome. Ironically, one of the
symptoms of dry eye can be excessive watering of the eyes. The
watering is a natural reflex caused by irritation to the eye
because the composition of the tears is incorrect. Normal tears
are comprised of three layers: the lipid, or oil layer; the
lacrimal, or watery layer; and the mucoid, or mucus layer. All
three layers of tears are necessary for proper lubrication.
Persons with dry eye syndrome have tears that are mostly water
and evaporate quickly, providing little protection for the eye.
Epiphora is an overflow of tears, usually caused by insufficient
drainage of the tear film from the eye. The most common cause is
looseness of the lower eyelids which prevents the eye from
draining the tears properly. The second most common cause is a
blockage of the lacrimal (tear) ducts located next to the nose.
However, epiphora may also result from the excessive production
Other causes of excessive tearing
are may be corneal disorders, dry eye syndrome, allergies,
inflammation of the eyelid (blepharitis), weakness of facial
muscles as the result of a stroke, and eyelashes rubbing on the
cornea. None of these causes are related to tear duct blockage.
Epiphora is a symptom rather than a disease and may be caused by
a variety of conditions.
The purpose of normal tears is to lubricate, nourish, and
protect the eye from dust and other irritants. Spread by
blinking (about every six seconds), tears keep the surface of
the eye optically clear and smooth, and also protect from
infection. Tears flow into the eye through ducts from tiny
glands located under the upper eyelids and drain from the eye
through the puncta (singular: punctum), which are small openings
near the nose.
A portion of tears evaporates,
but the excess normally drains into the nose via the lacrimal
canals and then into the throat or out through the nostrils.
These types of tears are made continuously and are known as
basal cell secretions. Reflex tears, on the other hand, are
those produced in response to emotions or when the eye is very
irritated. These are produced by a separate gland called the
lacrimal gland. Basal tearing is more important for the health
of the eye, but the volume of tears produced by the reflex
mechanism is larger.
It is important to differentiate
between chronic epiphora, acute epiphora, and normal tearing.
Chronic epiphora results from a long-standing or continuous
disorder, while acute epiphora usually results from a temporary
condition such as a foreign body in the eye or environmental
factors such as wind, pollen, eyestrain, emotional stress, and
sleep deprivation. The chronic variety nearly always requires
treatment by a professional, while acute epiphora may or may not
require treatment, depending on the severity of the condition.
Everyone experiences an occasional overflow of normal tears.
Occasionally children are born
with congenital epiphora, which is usually related to incomplete
development of the tear duct drainage system. This disorder
often disappears without treatment during the first six months
of life. If it remains, consult an oculofacial to determine the
cause and treatment.
What are the symptoms of epiphora?
Symptoms of epiphora include excessive tearing,
matting of the eyelashes, and mucous or pus-like discharge from
the puncta. Excess tearing can cause infection and, if left
untreated, could be detrimental to good vision. Eyelid
irritation is common because the area remains wet. Patients
often complain because they must constantly wipe their eyes.
When the epiphora is caused by
dry eye, a variety of measures can be employed to alleviate the
symptoms. Artificial tears in the form of eye drops are the most
common treatment. Many of these eye drops are available
over-the-counter and are used to lubricate the eye. Sometimes
the drops that are free of preservatives work better than the
preserved drops although they usually cost more. The first
prescription eye drop for the treatment of dry eye syndrome was
recently developed. Restasis may be helpful when the symptoms of
dry eye syndrome persist despite frequent use of artificial
tears. A humidified environment also helps in dry eye treatment
by adding moisture to the air and by helping prevent the
evaporation of tears. Frequent blinking to spread tears is
helpful, and avoiding smoke, wind, and other irritating
conditions may provide relief.
If the epiphora is due to eyelid inflammation (blepharitis),
corneal disorders or eye allergies (allergic conjunctivitis),
the oculofacial specialist can control your symptoms with the
proper use of prescription eye drops and other medical
Because epiphora can be caused by
a wide variety of disorders, a proper diagnosis by an oculofacial
specialist is necessary before treatment begins. If the
excessive tearing results from a punctal obstruction, the most
common treatment is for the doctor to open (dilate) the puncta
and wash it out (irrigate). This is a simple in-office
procedure, but is not a permanent solution and must be repeated
several times a year.
An obstruction of the
nasolacrimal duct (a tear duct that ends in the mucous membrane
of the nose) is often treated by a procedure called a
dacryocystorhinostomy (DCR). During the DCR procedure, the
obstruction in the duct is bypassed and a new tear duct is
created. Fortunately, this procedure has a very high rate of
success when performed by an experienced oculofacial
To effectively treat excessive tearing and
epiphora often requires a special understanding of the anatomy
and pathophysiology of the eyelid and of the lacrimal (tear)
system. Fellowship in the American Society of Oculofacial
Plastic and Reconstructive Surgery (ASOPRS) indicates that the
surgeon has greatest specialized training and expertise in this
have excessive tearing or epiphora, please consult with Dr. Kass
who is fully trained to treat this problem and has been in
practice in Tampa Bay for over 27 years.