Why have you got watery eyes?

Watering eyes in an adult can be due to many factors and conditions; including meibomian gland dysfunction and dry eyes when in fact it is not a watering eye or epiphora, but it is a condition called hyperlacrimation or hypersecretion. In this post, I am just going to talk about watering eyes due to epiphora as a result of blocked tear ducts.
The tear ducts carry away the tears from the corner of the eye, similar to a storm drain carrying away rainwater, and drain into your nose. They start by draining down from the puncta at the inner corners of the lids near the nose and then drain down into the sac and down the bigger duct into the back of the nose.
Persistent watering eyes often occur with ageing in older patients. It could be because of the eyelid not having a chance to catch the tears at the corner of the eye. That could happen if the eyelid is turning in (entropion) or turning out (ectropion), or it could be that there is a narrowing or complete obstruction of the duct.
In younger adults watering eyes can be caused by a tear drainage problem where the stenosis or obstruction is affecting the very fine tear duct such as the puncta and the canaliculi before the sac, and this can happen with medication such as chemotherapy drugs, epinephrine drops, and other eye drops including Echothiophate Iodide and Pilocarpine. Fortunately, none of these drops is used very often nowadays.
However, allergies and viral conjunctivitis including herpes simplex viral conjunctivitis can cause occlusion of these fine ducts, the puncta and canaliculi in young adult people.
Whatever the cause is, it has to be treated, so first of all the ophthalmologist has to work out what the cause of your watering eyes is and they have a long list of differentials which goes as follows.

1. Blepharitis
2. Blocked tear duct
3. Dry eyes
4. Ectropion
5. Foreign body
6. Hay fever
7. Ingrowing eyelashes and trichiasis
8. Tear duct infection, acute dacryocystitis
9. Keratitis
10. Pink eye conjunctivitis
11. Trachoma
12. Bells palsy, facial palsy
13. Chemical splash
14. Chronic Sinusitis
15. Radiation therapy
16. Sarcoidosis
17. Rheumatoid arthritis
18. Thyroid eye disease
19. Wegener’s granulomatosis
20. Surgery on the eye and nose

So, there are at least 21 easily identifiable causes of watering eye and I know I have left many of them out!
The ophthalmologist, for adult patients with watering eyes, has to determine which of those 21 (or more) causes your watering eye. Is it

• a simple blocked nasolacrimal tear duct,
• are the muscles that hold the inner part of the eyelid working well,
• is the eye drying out,
• is there chronic irritation,
• or is there a more acute problem causing the watering eyes or a systemic problem?

You need to see your oculoplastic lacrimal ophthalmologist for an accurate diagnosis. At Clinica London, we have the Tears Clinic where we diagnose the cause of your watering eyes by taking the history and by doing an assessment. The assessment includes the slip lamp, biomicroscope, dye tests, probing and syringing and nasal endoscopic examination of the inside of the nose where the tear duct typically drains the tears.