Watery Eye or Epifora
Watery eye, is one of the most often seen symptoms in ophthalmology and which causes great nuisance to the general public. Non permanent watery eyes are quite common in daily life, being associated with eyelid misplacement of the eyelid, the tear drainage canal, exposure to the wind and cold, and emotional states. In most cases these are normal reactions and do not usually require any treatment whatsoever. However, there is another range of situations which are pathological and distressing where the person’s eyes water constantly, requiring proper evaluation by an Ophthalmologist. I am only going to refer to this latter pathology in this article.
The tear canal is the drainage path taken by tears which are secreted by the tear glands situated under the eyelid in the external upper quadrant and which drain away at the side of the nose.
Any problem which obstructs this duct will cause the common symptom of having a watery eye owing to the lack of correct drainage. This wateryness can be constant and would be very distressing for the person since it will interfere with their everyday living. Added to this and even more importantly, it can be a source of repeated infections which will greatly affect the suffer’s quality of life. It must be noted that, if a person is to have eye surgery, for example for cataracts, then it will be necessary to resolve the obstucted tear duct prior to the operation
What causes watery eyes?
In the majority of cases an obstruction at some level of the tear duct, usually at the opening by the nose.It is more frequent in adults over 50 although it is true that less so nowadays owing to better hygiene in the general population. Even so, this Watery Eye condition, or Epifora in medical terms, continues to be a frequent reason for consultation.
¿What disorders can we find related to Watery Eye?
In medicine, all secretions which accumulate tend to get infected. In the case of poor drainage of the tearduct, an accumulation can therefore set off a secondary infection.When the lagrimal sac becomes infected it is known as Dacriocistitis, which can basically lead to three clinical patterns:
This happens mostly in adults, producing inflammation and acute pain in the area of the internal palpebral angle . This inflammation can be so bad that it will extend to the nose, cheek and face. It is accompanied by purulent secretions under the lid and lacrimal lake, accumulated pus can break out spontaneously . Treatment includes administering wide application antibiotics either by mouth or injection and applying hot compresses. Some cases require hospitalisation in order to control the infection better.
Commonly known as Rija, the symptoms are less noticible and are usually limited to cronic watering, redness of the eye and secretions. Treatment is normally surgical.
Newborn Baby Dacriocistitis
In newborn babies, the tear duct by the nose normally opens in the first month of life. However, in some cases this drainage duct takes longer to start opening up and in 5% of cases does not come about spontaneously. It is a clinical syndrome which causes great concern to parents who see that the baby’s eye is constantly watery with secretions and a swollen eyelid. Treatment usually starts with local antibiotics and massage of the tear duct to try to open up this drainage canal. If this is not successful in the first six months of life then it is usual to resort to perforating the duct opening with a suitable instrument.
How is it diagnosed?
The main symptom of obstruction of the tear drainage canal is a watery eye. If this includes secretions and a bloodshot eye we can suspect that we are looking at a case of Dacriocistitis. Other more specific examinations would be to instill fluoresceinina and observe its behaviour, open up and irrigate the tear canal and, in order to confirm it, take an X-ray with contrast in the canal. This is called Dacriocistography. Also carry out a TAC or RMN in order to discount other pathologies.
What treatment is there?
Treatment of obstruction in the tear duct or canal is normally surgical, in essence, to reestablish a complete drainage of the canal. The technique is known as Dacriocistorrinostomy and we can choose from various types, all with a 90% success rate.
- External Dacriocistorrinostomy is carried out through a little cut in the skin in the area of the lacrimal sac opening. It has the drawback of sometimes leaving an unaesthetic scar and occasionally there is profuse bleeding which makes surgery difficult. Even so, it is the most effective treatment.
- Endonasal Dacriocistorrinostomy where all the surgery is internal, by way of the nostril, and leaves no visible scar.
- Technical advances using fibre optics, applied in endoscopic form with an added diodode laser, have allowed a less aggresive way to approach this problem by following the natural tear drainage canal . This has the advantage of being quicker, with hardly any bleeding , less pain also less post surgery complications which let the patient, in most cases, return to work the next day.
Points to remember are that sporadically watering eyes are normal and do not usually need any treatment. On the other hand, if we notice an uncomfortable, permanently watering eye, which does not get better with drops or medication, then we must think about paying a visit to the Ophthalmologist as the cause could be an eye pathology with more serious consequences.
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