Epiphora: Causes, Symptoms, and Treatments
Introduction
Epiphora, commonly known as watering eyes, is a condition characterized by an overflow of tears onto the face, often due to an imbalance between tear production and tear drainage. While tears play a crucial role in maintaining eye health by lubricating the eyes, flushing out foreign particles, and providing nutrients, excessive tearing can be both uncomfortable and indicative of underlying issues.
Causes of Epiphora
Epiphora can be caused by a variety of factors, broadly categorized into two groups: increased tear production and impaired tear drainage.
1. Increased Tear Production
- Allergies: Allergic reactions to pollen, dust, pet dander, or other allergens can lead to inflammation and increased tear production .
- Infections: Conditions like conjunctivitis (pink eye), caused by bacteria or viruses, can stimulate excess tear production as the body attempts to flush out the infection .
- Environmental Irritants: Exposure to smoke, wind, bright light, or chemicals can irritate the eyes, prompting an increase in tears.
- Eye Strain: Prolonged periods of reading, computer use, or other activities that strain the eyes can lead to reflex tearing.
2. Impaired Tear Drainage
- Nasolacrimal Duct Obstruction: Blockage in the tear drainage system, such as the nasolacrimal duct, prevents tears from draining properly. This is common in infants and older adults .
- Eyelid Malpositions: Conditions like ectropion (outward turning of the eyelid) or entropion (inward turning of the eyelid) can affect the tear drainage process.
- Tear Duct Infections or Inflammation: Infections or inflammation of the tear ducts can obstruct tear flow.
- Age-related Changes: With age, the eyelids may lose muscle tone, impacting the proper drainage of tears.
Symptoms of Epiphora
The primary symptom of epiphora is excessive tearing. Additional symptoms may include:
- Blurred vision due to tear film accumulation.
- Redness and irritation of the eyes.
- Discomfort or pain, particularly if the underlying cause is infection or blockage.
- Swelling around the eyes or nose in cases of tear duct obstruction.
Diagnosis of Epiphora 
Diagnosing epiphora involves a comprehensive eye examination to identify the underlying cause. Key diagnostic methods include:
- Patient History: Discussing the onset, duration, and associated symptoms of tearing.
- Physical Examination: Inspecting the eyes, eyelids, and tear ducts for signs of infection, inflammation, or structural abnormalities.
- Tear Drainage Tests: Using dye tests (e.g., fluorescein dye disappearance test) to assess tear drainage efficiency. - Imaging Studies: Utilizing imaging techniques like dacryocystography or nasal endoscopy to visualize blockages or anatomical issues within the tear drainage system.
Treatment Options
The treatment of epiphora depends on its underlying cause:
1. Medical Treatments
- Allergy Management: Antihistamines or allergy eye drops can reduce allergic reactions and subsequent tearing .
- Infection Control: Antibiotic or antiviral eye drops may be prescribed for bacterial or viral infections, respectively.
- Anti-inflammatory Medications: Steroid eye drops may be used to reduce inflammation causing excessive tearing.
2. Surgical Treatments
- Dacryocystorhinostomy (DCR): A surgical procedure to create a new tear drainage pathway between the eye and the nasal cavity, often used for nasolacrimal duct obstructions.
- Punctal Plugs or Stents: Tiny devices inserted into the tear ducts to keep them open and facilitate proper tear drainage.
- Eyelid Surgery: Corrective surgeries for ectropion or entropion to restore proper eyelid positioning and function.
3. Non-Surgical Treatments
- Warm Compresses and Massage: Applying warm compresses and massaging the tear ducts can help alleviate minor blockages.
- Lubricating Eye Drops: Artificial tears can help manage irritation and maintain eye lubrication.
Conclusion
Epiphora is a multifaceted condition that can significantly impact daily life. Understanding its causes, symptoms, and treatment options is crucial for effective management. If you experience persistent or severe tearing, seeking an evaluation from an eye care professional is essential for determining the appropriate course of action and ensuring optimal eye health.
References
1. "Allergies and Epiphora". American Academy of Ophthalmology, 2023.
2. "Conjunctivitis (Pink Eye)." Centers for Disease Control and Prevention (CDC), 2022.
3. "Nasolacrimal Duct Obstruction." Mayo Clinic, 2021.
4. "Treatments for Watery Eyes." NHS, 2022.
