Watery eyes, causes and treatment of tearing
Most of us will experience episodes of excessive watering in our eyes at some point in our lives. These can be self-limiting and respond to a specific cause, or they can appear without apparent cause and become a chronic, bothersome part of our daily lives.
We can divide the causes of tearing into two main types: those related to an ophthalmological disorder, or those related to the tear drainage system.
Ophthalmological causes that can lead to tearing
Any ophthalmic condition that causes irritation of the ocular surface can cause tearing. For example, conjunctivitis , whether infectious or allergic, or a corneal disorder in the form of keratitis. Keratitis can occur after eye surgery, excessive sun exposure , chlorine in swimming pools, excessive contact lens use , or after ocular trauma affecting the cornea. These types of cases are easy to diagnose because they are usually accompanied by an identifiable cause, and an eye examination will lead to the appropriate diagnosis and treatment.
There is another large group of ophthalmological causes of tearing that are caused by alterations in the tear film . Traditionally, these have been classified under a catch-all term called “dry eye,” but today we know that this is a simplification that doesn’t reflect reality and doesn’t help patients understand their problem. Any alteration in the proper composition of tears can lead to eye irritation, which can be very mild, accompanied by watering or a sensation of wet eyes. Tear film alterations include those in which there is a decrease in tear production, the classic dry eye , and those in which the composition is altered. Dry eye due to decreased tear production usually occurs in patients over 50 years of age and older and may be related to immunological diseases such as Sjögren’s disease, rheumatoid arthritis, and others.
On the other hand, an alteration in tear composition caused by dysfunction in the meibomian glands is becoming increasingly common among younger patients. These glands produce what is known as meibum, an oily secretion that forms part of the tear film and gives it stability. For reasons that are not entirely understood, these glands can fail, leading to dry eye, often called “evaporative,” since the absence of meibum in the tear means it lasts only a short time on the ocular surface. This causes patients eye strain when using the computer, discomfort, tearing, eye redness, and sometimes even a stye or chalazion. The causes of glandular dysfunction are multiple: stress, poor diet, blepharitis, poor eye hygiene, etc.
Alterations in the tear drainage system
Tears normally drain into the nose through blinking, which pumps them into the tear ducts. Any disruption to this series of ducts can lead to drainage interruptions and, consequently, watery eyes. Tear ducts can become blocked at their beginning, known as the puncta, in their middle portion (tear canaliculi), or at their end, known as the nasolacrimal duct.
Tear duct obstruction generally has no specific cause and tends to appear in older patients, although it can affect younger patients. Tear duct obstruction frequently presents as unilateral tearing , without significant signs of irritation. It simply represents one eye that is moist, while the other eye is fine. When tearing occurs unilaterally, it usually leads the ophthalmologist to suspect tear duct obstruction, and an examination can diagnose it.
Treatment of tearing
It will be aimed at the cause of the problem. If there is a tear duct obstruction, treatment will always be surgical, and it has a high success rate.
Treatment for ophthalmic causes will vary greatly depending on the cause. Treatment can be frustrating in cases of meibomian gland dysfunction. These cases should always be accompanied by oral supplementation with omega-3 preparations and antioxidants such as astaxanthin. In addition, a combination of other treatments such as glandular massage or intense pulsed light may be necessary to ensure the patient maintains an adequate quality of life.
