No need to cry – Strategies for chronically dry, watering and irritable eyes
Tears are produced by the lacrimal glands and drained away through fine passages at the inner corner of the eyelids into the nose. Tears are essential in keeping the surface of the eye clear, moist and healthy. Blinking spreads the tears evenly across the cornea which acts as the ‘windscreen’ of the eye to allow us to achieve optimum vision.
The most common cause of excessive tear production (reflex tearing) is caused by Dry Eye Disease (DED). In this case poor quality tears do not sufficiently wet the cornea and nerve fibres on the surface of the eye send signals to the tear gland to produce more and more tears.
Common causes of under-drainage may result from eyelid problems or the narrowing or blockage of tear drainage channels.
A consultation and examination is essential to establish the main cause of the watering eye. This will involve tear duct syringing to test the patency of the tear drainage system.
Irritable, red, watering, tired, burning, itching eyes, fluctuation in vision, contact lens intolerance are common Symptoms associated with dry eyes . A major study of 690 patients with Dry Eye Disease assessed vision related quality of life and showed significant problems on reading , Watching TV, Computer use and driving.
As this condition is not sight threatening, the correct diagnosis, investigation and management of often trivialized, even amongst specialists often resulting in suboptimal management.
How Common is it?
It has been shown in large populations studies Dry Eyes affect 5- 30 % of those over the age of 50 – many millions in the UK.
A second wave for the dry eye epidemic is due to the explosive rise in laser refractive surgery for (short sightedness. It is estimated that 100,000 procedures are carried out every year in the UK. Symptoms of dryness may occur in more than 50% and severe.
What causes Watery eyes?
One of the most common causes of occasional watering eye is dry eyes as the irritation sends signals to the tear glands to secrete more tears. However significant watering eye (when the tears over flow and causes blurring of the vision, needing constant wiping can suggest there may be a problem with the tear drainage.
Is there a cure for Dry Eyes?
A permanent and definitive treatment for Dry Eye is still not yet available. However over recent years there has been significant scientific progress in the diagnosis, monitoring and treatment of dry eye and blepharitis/meibomian gland disease. These new advances can make the symptoms of the disease more controllable.
This may involve the use of omega supplements, heat masks and eyelid massage to improve the quality of your own tears, supplementing with eyedrops and sometimes using antibiotic and steroid treatments to decrease the inflammation associated with the dry eye. Some new modalities such as LipiFlow and Intense Pulse Light treatments may benefit dry eye management as well.
Is there a cure for watering eyes?
Excessive production or under-drainage of tears can lead to tears flowing down the cheeks. This may cause blurring of vision, interfere with daily visual tasks and may be socially embarrassing. If severe, this may require the attention of an eye and eyelid specialist.
If the watering is mainly due to dry eye then this has to be treated first but if poor drainage is the main cause of the watering then the cause needs to be determined. In some patients, eyelid surgery may be recommended, in others, minor surgery to enlarge the punctum (opening)of the tear duct drainage system (puncto-canaliculoplasty) may be enough to control the watering. In more severe cases a tear duct bypass operation called DCR (DacryoCystoRhinostomy) may be required to bring relief.
External DCR procedure
The DCR operation is performed through a 1-1.5 cm incision on the side of the nose where the scar is often invisible. The surgeon bypasses the narrowing or blockage in the tear duct by joining the lining of the tear sac to the lining of the nose. This newly made passageway is initially kept open by small polythene rods/tubes. These are removed in the outpatient clinic in the ensuing weeks or months after surgery, depending on the severity of the blockage.
Endonasal DCR procedure
In some patients the surgery can be performed endonasally (from the inside of the nose). This avoids an external scar. However this may not be suitable for some types of tear duct obstruction. Again the passageways are kept open by the small plastic rods which are removed later when the rhinostomy (the new passage between the tear sac and the lining of the nose) has healed sufficiently.