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Is your eye watering or feeling dry?

The balance between a watering and a dry eye

Watering eyes can be down to a blocked tear duct or a reactive over-production of tears when the eyes feel dry.
This problem is one of my biggest clinical challenges. Does the patient have a watering eye or a dry eye, or is there an imbalance between the two?
Today I saw a patient at Clinica London, who we know has a narrow tear duct and does not fully drain her tears, so she gets a watery eye. She has a dilated tear sac and produces some mucus, which refluxes back over her eye from time to time and makes her eye feel sticky in the morning. Her watering eye is worse when she goes out.
Normally, this would indicate the need for further imaging tests, which would most likely lead to a tear duct operation, such as a dacryocystorhinostomy. However, this very patient also has bad blepharitis and, because she is aged 63, she already has dry eyes. Blepharitis and dry eyes cause her to produce excess tears, which her narrow tear duct cannot drain.
Often with the older patient, there is a happy medium between tearing from a narrowed drainage duct and relative dry eyes. When the tearing and dry eyes are in balance, those patients do not come to see me. You could say that it is an evolutionary advantage to have slight narrowing of your tear ducts, which stops you from draining all your tears, because as we get older our tear production declines.
People aged 60 or over have an element of dry eyes. So if you are producing fewer tears, but you are also draining fewer, you are going to have a reasonable balance between watering and dry eyes. You will be comfortable, without any symptoms of watering or dry eyes. It is when this balance is out of kilter that it becomes more difficult.


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