The Eye Practice

Watery eyes have so many causes – not the least of which is a blocked tear duct. 

The inner corner of your eye is where your tear ducts are situated. Known as the puncta, they are responsible for draining your excess tears from your eyes and down into the nose. If the puncta are blocked for any reason, the tears will remain on the surface of your eye, and they will spill out over your eyelids and onto your face. The blockage can be partial, or complete – and this will result in the severity of overflow of tears, known as epiphora.

While watery eyes can be a major symptom of a blocked tear duct or ducts, there are other symptoms associated with this problem as well, including:

•    Recurrent episodes of conjunctivitis and other eye infections (such as dacryocystitis).

•    Blurred vision.

•    Blood in tears (tears will be stained pink or red).

•    Mucus discharge from the eye (regardless of conjunctivitis).

•    Swelling, tenderness, or pain at the inner corner of the eye, where the tear ducts are located.

While the puncta are commonly the culprit of blockage, it can occur at any part of the tear duct system, such as the canaliculi – the canals in the lids that carry the tears to the sac on the side of the nose (called the lacrimal sac). In fact, any part of the system can be blocked, including the nose, and result in watery eyes.

 

So what causes these blockages to occur? There are several causes of blocked tear ducts:

•    Congenital defects: Down syndrome, duct abnormalities, or tissue over the nasolacrimal duct can cause this problem.

•    Facial injuries or eye trauma: If a facial or eye injury is present, a problem with bone or cartilage damage can cause the blockage.

•    Aging: Growing older can change the shape of the eye, causing blockages in the puncta.

•    Tumors, cysts, and foreign objects: Benign or cancerous tumors or cysts can develop, as well as grit from the duct system can create an obstruction.

•    Eye infections: Inflammation and mucous can plug the area, causing the ducts to become blocked.

•    Medications: Topical eyedrops, and certain chemotherapy treatments (such as Taxotere) can have a possible side effect of tear duct obstruction.

If left untreated, complications can occur. The tears in your eye need to move, as any liquid becoming stagnant in the body is more open to infections – bacterial and fungal. Additionally, viruses can be opportunistic and penetrate the area, causing further problems. These infections can lead to eye damage and vision impairment.

If you have watery eyes, it is best to find out the cause by visiting your eye care professional, before infections get a chance to set in. Treatments depend entirely upon what is causing the problem. Irrigation, surgery, tumor removal or shrinkage attempts (depending on the cause of the tumor), and massage techniques are all used to unblock the tear duct system.

Make an appointment to see Dr Jim Kokkinakis if you have watery eyes on (02) 9290 1899.  Even though some forms of watery eyes might need referral to a specialised ophthalmologist called an oculoplastic ophthalmologist, often no referral is required and can be treated in house.

Watery Eyes can have many causes.  Some can be simple to fix, yet other causes might require surgery.

The very opposite of entropion is called ectropion (eck-TROH-pee-on). It is a condition in which some of the eyelid, or all of the eyelid, turns outward. This turning outward typically strikes the lower eyelid, and is quite irritating to the eye. The globe of your eye (your eyeball), and your inner eyelid are exposed to the air. This can dry your eyes out, and, ironically enough, when your eyes start to dry out, you will produce tears to try to compensate.

One of the signs and symptoms of ectropion is watery eyes.

There are many causes of ectropion – most are from problems with the surrounding muscle and tissue of the eyelid.

          

•Surgery: Over-correction of previous problems, such as entropion, can cause ectropion. This can also happen with cosmetic eye surgeries, or radiation therapy to treat certain cancerous growths.

• Congenital disorders: People with Down syndrome are sometimes born with ectropion.

• Weight loss surgery and other rapid weight loss: If you have had recent, rapid weight loss, ectropion can occur.

• Growths: Any kind of growths on the eyelid can cause this problem.

• Muscle problems: Weakness in the muscles or facial paralysis (often seen with Bell's palsy), can relax the lid too much, causing it to droop. Aging can also cause this weakness to occur, causing ectropion.

• Scars: Scarring and trauma to the eyelids can also cause this disorder.
Because the eyelid is pulled away from the eyeball, your eye will not drain properly. This can cause the three major signs and symptoms of ectropion:

• Epiphora – the excessive overflow of tears is twofold. One, your eyes are trying to compensate for being dried out, and two, your puncta (the little tear ducts at the inner corner of your eye) are not draining properly.

• Gritty feeling in the affected eye.

• Irritation and burning in the affected eye.
Sagging or drooping eyelids are also a sign of ectropion.

If left untreated, ectropion can lead to serious problems with the eye, including corneal ulcers, and corneal abrasions. These complications can lead to permanent vision loss. Therefore, if you have any of these symptoms, it is important to see your eye care professional right away, as he or she can give you eyedrops and ointments to use to prevent damage until you can have surgical correction.

Surgical treatment varies, depending on the cause of your ectropion. Scar tissue may need to be managed, and other surgical procedures may be necessary. You will likely be given drops and ointments to use at home until the time of your surgery. In other words, don't try to treat this at home – the complications can be serious.

If you are experiencing any of the symptoms of ectropion, and have noticed that your eye lids are drooping, and have watery eyes, come and see Dr Jim Kokkinakis for advice. Though it may require referral to an oculoplastic ophthalmologist, it is well worth saving your sight!  It is imperative that you are referred to the right ophthalmologist that specialises in correcting ec tropion.

Watery Eyes has many causes:

Ingrowing or ingrown eyelashes can cause watery eyes. The medical term for this condition is called trichiasis (trick-eye-ah-sis). When the eyelashes are misdirected, instead of growing outward as you would expect, the lash grows inward, heading for the eyeball or eyelid (conjunctiva). Not only is this condition quite uncomfortable from the constant rubbing of the lashes inward, it created epiphora (watery eyes).

Trichiasis can affect the entire lash set (your entire upper or lower lid), or, it can affect a small portion of the lashes. The former is called diffuse, and the latter is called simple trichiasis. But what causes the lashes to grow in the wrong direction?

There are several causes that can make your lashes grow in the wrong direction.

•    Infections: Though this is rare in the United States, an infection of the eye called Trachoma can cause the eyelashes to grow inward. Another infection that can do this is herpes zoster.

•    Autoimmune disorders: Stevens-Johnson Syndrome (SJS) and seasonal allergic reaction called Vernal keratoconjunctivitis (VKC), which typically occurs in Spring (hence the use of the term Vernal).

•    Eye trauma: Injuries, over-correction in surgery, chemical burns, and thermal burns are a few ways that the eyelids can be affected, causing the lashes to grow in the wrong direction.

•    Entropion: When the edges of the eyelid turn inward, either due to aging, a congenital condition, or other reasons, the lashes grow toward the eye.

•    Epiblepharon: A typically congenital condition that presents with a redundant skin fold under the eyelid, pushing the lashes toward the eye. This is common amongst Asian children.

•    Distichiasis: This can be either acquired or congenital – when the eyelashes grow out of the meibomian glands (that produce oily tears) at the inner eyelid.

 

Treatment for trichiasis depends entirely upon how you have acquired it. However, surgical treatment is a primary requirement to help encourage your lashes to grow in the right direction.

For simple trichiasis, carefully removing the offending lashes and follicles will be used.This is very simple and if done correctly can redirect the eyelashes away from the eye and hence stop the watery, irritated eyes.  This procedure is safe and non-surgical.  It is certainly the preferred approach before trying more aggressive options.

In more complicated cases, surgeries include repositioning of the lashes, repositioning of the eyelid (particularly in the case of entropion), or removal of the redundant skin fold or folds in the case of epiblepharon.  This should be done by an oculoplastic trained eye surgeon.

If you have a more serious disorder, such as Stevens-Johnson Syndrome, your referred specialist, will gear your therapeutic treatments toward managing SJS or other disorder that you have. Managing the underlying cause is important to ensuring that trichiasis isn't a repeat offender in your eye.

Trichiasis can cause problems with your eye, including scarring and vision impairment. Therefore, if you have any symptoms of watery eyes, and discomfort, and notice that some of your lashes poke your eyes or otherwise irritate them, don't try to solve it yourself (as in pulling them out with tweezers – that can be dangerous and make things worse).

Visit Dr Jim Kokkinakis at The Eye Practice, who will be able to help you with trichiasis, and prescribe therapeutic measures to treat it, and prevent future incidents.  Call now on 9290 1899 for an appointment.

Watery Eyes is another one of those common symptoms that annoys patients and practitioners.  Like dry eyes it is often ignored even though most watery eye causes have a solution if analysed and treated properly.

So why are you crying when you're not sad? The easy answer is that you have epiphora – watery eyes. The more challenging part is figuring out what causes those watery eyes!

Basically, there are two main causes of epiphora – either from a blocked tear duct, or an overproduction of tears due to irritants. Once the main cause is identified, a sub-cause has to be identified, such as canaliculitis, ectropion, conjunctivitis (allergic, bacterial, or viral), dacryocystitis, or even ingrown eyelashes, and other causes.

• Canaliculitis: Tears drain from the puncta (at the inner corner of your eye) into the canaliculus. If the canaliculus becomes inflamed or blocked, the tears will “back up” into the eye, and spill over.  The picture below shows a blocked infected canaliculus. This needs treatment with antibiotics.

• Dacryocystitis: Congenital dacryocystitis is a rare but serious condition in newborns and must be treated promptly. Dacryocystitis in adults is when the tear sac itself is inflamed, which blocks the ducts and prevents tear (lacrimal) drainage. This can cause overflow of tears ans watery eyes.

• Conjunctivitis: Allergies, bacteria, and viruses are all causes of conjunctivitis – the lining of the eyelids becomes irritated and swells – this membrane is called the conjunctiva, hence the name conjunctivitis. Watery eyes are commonly seen with this condition.

• Ingrown eyelashes: Known as trichiasis (trick-eye-ah-sis) among medical professionals, this is exactly like it sounds – the eyelash grows inward towards the the eye, and can cause infections and scarring if you do not treat it promptly.

• Ectropion: This condition should be treated right away to prevent infections and scarring to the eye. Ectropion is the name of the condition where the eyelid, typically the lower eyelid, folds inward towards the eye. It is not only the cause of watery eyes, it is also quite uncomfortable. Treatment is a simple surgery, and the outlook for patients with ectropion is good, especially if it is treated prior to corneal damage.

• Entropion is the opposite of ectropion, where the bottom lid droops down and away from the eye.  This in turn takes the puncta (drain of the eye) away from the tears of the eye, which then cannot drain away.  They overflow and watery eyes or epiphora is the consequence.  Surgery by an oculoplastic surgeon is the way to fix this problem.

• Foreign objects or eye injury: Dirt, sand, grit, pebbles, pollen, dander, and dust can get into the eye, making the tears produce in an attempt to wash out the foreign object. If the eye is injured, you will also produce tears to try to keep the eye safe.

• Dry Eyes can be a cause of watery eyes!  This sounds ridiculous but can happen when the eyes get excessively dry.  Irritation finally sets in, which them stimulates the tear gland to over produce tears.  the problem with these tears that are produced in reflex to a dry eye is that they are usually quite salty.  Patients with this condition typically complain of their eyes burning and stinging.

• Other causes: Other causes of watery eyes can include simple allergies, sleep deprivation, eyestrain, and emotional stress.

You can see that the causes of watery eyes are quite diverse, and many causes require immediate treatment to avoid damage to the eye. While the above list is not an exhaustive one, it is a list of the most common causes. Many of these causes can be treated with good results, particularly if they are treated early, before the condition has a chance to do any damage to the eye (which could result in permanent vision loss).

Tears are a necessary part of protecting the eye, but a constant overproduction can be not only annoying, but dangerous (especially if you're trying to drive) in some cases. If you're having trouble with watery eyes, consult us at The Eye Practice for a proper diagnosis and then a treatment plan.