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 Encyclopedia - Epiphora

What causes epiphora?
What are the symptoms of epiphora?

Epiphora is an overflow of tears, usually caused by insufficient drainage of the tear film from the eye. The most common cause is a blockage of the lacrimal (tear) ducts located next to the nose (See Anatomy of the Eye), but the condition may also result from the excessive production of tears. 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 ophthalmologist to determine the cause and treatment.

What causes epiphora?

The most common cause of epiphora is blockage of the lacrimal ducts located along the nose. This blockage can be from a variety of causes including membrane inflammation, injury, or tumors. In adults, tear duct blockage can occur at any point in the lacrimal system from the punctum to the bottom of the nose.

Other causes of excess tearing may be corneal disorders, lower eyelid looseness, 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.

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.

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.

Because epiphora can be caused by a wide variety of disorders, a proper diagnosis by an eye doctor 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 with a balloon-tipped probe creating a new passage as it is inflated. A temporary tube is then left in place to keep the new passage from scarring and closing. No incision is required, and the procedure can be performed under local anesthesia in an ophthalmologist's office.

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 eyedrops are the most common treatment. Many of these eyedrops are available over-the-counter and are used to lubricate the eye. 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 excessive tearing lasts for an extended period of time, see an ophthalmologist to determine the exact cause so that appropriate treatment can be initiated.

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