Excessive Tearing

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One of the most common, and frustrating, problems that patients have is excessive tearing. This is a condition that shows up for many reasons. Occasionally, this is a spontaneous problem that arises suddenly one day or while doing a certain activity. In other cases, an infection or injury causes tearing. In still other cases, patients have a long history, sometimes over many years, of tearing. Tearing, though, can be a complicated, multifactorial condition and requires a thorough evaluation.
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Why are my eyes watery?

The short answer to this question is an imbalance between the amount of tears your tear gland is producing, and how well your tear drains are able to drain the tears away. The common analogy that Dr. Dewan likes to use is that of a sink. If your eye is the bowl of the sink, imagine that your tear glands are the faucet and the tear drains are the sink drain. If there is too much tear production, the drains can’t keep up and the sink bowl overflows. Similarly, if the drain is plugged, it can’t keep up with your tear production and the sink overflows.

I was told I am tearing because of dry eye. How does that make sense?

This is why tearing is more complicated than the short answer above! In fact, dry eye is the most common cause of tearing. In effect, what happens is that the body is very good at sensing when something is wrong. Our eyes, for instance, need to have a certain level of wetness on the surface, or we start to feel eye irritation. Our eyes lubricate themselves by producing tears, which our blinks then wipe across the surface of the eye. If the eye senses dryness, the body has a reflex to make more tears to “fix” the problem. Unfortunately, our tears are also more complicated than we think. In this “reflexive tearing,” not every component of our tears can be produced as quickly as necessary. Consequently, our eye relies on a flood of thin, watery tears to lubricate the surface of the eye, as opposed to thicker, better hydrating tears. As a result, when our eyes are dry, we get a lot of watery tears that may overcome our drains, resulting in a wet eye.
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So how do we figure out what is causing my tearing?

The most important part of fixing your tearing is a thorough history and examination. Because of the complicated nature of tearing, Dr. Dewan will ask a series of important, pointed questions, and also conduct an exam and perform a few necessary tests in the office to determine your cause of tearing.

What type of tests are necessary?

Aside from examining your eye, there are 3 tests that Dr. Dewan will perform. First, he will use a special yellow dye to highlight your tears as he looks at them during your exam. This allows him to see how well the passive drainage of your tears is working. Second, he will measure your baseline tear production which will indicate if your tear glands produce too many or too few tears. Lastly, he will perform an irrigation of your tear drains to check if there is any resistance to flow through your drain system. Additionally, he will check the tension of your lower eyelids, and look for irritation on the surface of your eyes, and inflammation inside your nose.

OK, so now that we know that my tear drain is blocked, how is this fixed?

Tear drain obstruction is surgically repaired with a procedure called a dacryocystorhinostomy, which we call a DCR. This is a surgery performed in the surgery center with you completely asleep. A small incision is made on the side of your nose near the corner of your eye. Through this incision, a new passageway is constructed for tears to drain into your nose, very close to where they normally drain. A silicone stent is placed in this new passageway and the incision is closed. The stent will stay in place for 3-4 months and be removed in the office.

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What is the recovery like from DCR?

Recovery from DCR is usually uneventful. Most patients have a light discomfort for the first 1-2 days following surgery. This is typically treated with Tylenol or ibuprofen. Some patients may have a little blood in their nose or tear film for 1-2 days as well. There are very few restrictions placed on patients following the surgery, and patients can shower and wash their face normally. We do ask that patients do not rub their eyes as this can dislodge the stent. If the stent is removed prematurely, it may reduce the overall success of the surgery.

How is tearing treated if I don’t have a tear drain blockage?

Depending upon what your evaluation shows, Dr. Dewan may recommend treatment from a variety of options:

  • For patients who have purely dry eye related tearing, we encourage patients to develop a regimen of lubrication of their eyes with artificial tears. For particularly dry patients, Dr. Dewan may prescribe a medication to help increase tear production.
  • For patients with a partial obstruction of their tear drain, we often prescribe medications, including nasal sprays and medicated eye drops to reduce internal inflammation and increase tear drainage.
  • Some patients have tearing related to loose eyelids (ectropion), and lid tightening surgery may be recommended to them.
  • Some patients might have small tear drain openings, preventing tears from efficiently being drained away. Dr. Dewan may recommend a surgery to widen these openings.
  • For patients with excessive tear production, oral medications can help dry the eyes, and in some cases Botox injections to the tear gland can be used to improve the tearing.

I’m ready to improve my tearing! What is the next step?

We are happy to help! Schedule a consultation with Dr. Dewan by calling our office. Expect a visit to take 45-60 minutes as Dr. Dewan will thoroughly examine you and perform the above-mentioned tests. He will then discuss his findings with you and present you with a customized treatment plan for your tearing.
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