Causes of Eye Tearing

Eye tearing can result from one or more causes, and sometimes they can occur individually or simultaneously. Proper management of eye tearing conditions starts from identifying the root cause of the problem. below are the three main causes of excessive eye tearing:

  • Increased reflex tearing
  • Eyelid position & dynamics
  • Lacrimal drainage system problem (malformation, stenosis, or obstruction)

Eye Tearing Treatment

Reflex Tearing

Increased reflex tearing may be caused by inflammation, allergies, or infections (such as pink eye). Treatment of these cases is controlled through medication. Reflex tearing can also be caused by common dry eye condition. Treatments for this condition may include lubricants drops, gels, ointment and other specialized medications. Another problem that may cause reflex tearing is external surface malformation of the eye. This is where plastic eye surgery is needed to treat the specific malformation.

Eyelid Position and Dynamics

Eyelids position, margins, and dynamics can be another major cause of eye tearing. An eyelid specific inflammation called blepharitis, which is associated to a bacterial eye infection due to improper eyelid hygiene can be the cause of tear overflow. In these cases, a complete eyelid hygiene regimen is recommended and may include eyelid scrubs and other cleansing agents. Eyelid hygiene is the cornerstone of treatment for most cases of blepharitis. Besides a program of eyelid hygiene, the severity of the blepharitis and related symptoms may require supplemental treatment with topical and oral medicine. Other types of conditions needs surgical intervention rather than medicinal. For example, Trichiasis, or rubbing lashes, is a common eyelid abnormality where the eyelashes grow inwards toward the eye and causes over secretion. In some cases, eyelid margins can lead to the tear duct drainage system to malfunction, which in turn leads to excessive eye tearing. These cases will also need surgical intervention to treat the problem. Other kinds of eyelid surgical treatments include :

  • Entropion Repair (out-turning of the eyelid)
  • Lateral Canthal Tendon (LCT Laxity) Repair
  • and Ectropion Repair with Punctal Eversion correction

Under Drainage

The third major cause of eye tearing is related to problems with the lacrimal drainage system. The image below illustrates the anatomy of this system.

Eye Tearing
  • Puncti (upper and lower)

  • Canaliculi (upper & lower)

  • Common Canaliculus (May not exist)

  • Lacrimal Sac 10mm

  • Nasolacrimal Duct 12mm

Signs of the drainage system not functioning properly include tears accumulating nasally and high tear meniscus. Diagnosing the exact problem include tests using Jones Dye Test, probing, and syringing tests. these test are well-tolerated and safe procedures that provide useful information in order to assist in choosing the ideal surgical plan. Managing under drainage problems includes many types of surgeries and procedures, including Dacryocystorhinostomy (DCR), which is a surgical operation used to restore proper tear drainage into the nose by forming a new tear drain between the eye and nose when it has been blocked or narrowed.