Tearing Disorders

Tears are produced constantly by the lacrimal gland which is located under the upper eyelid. Tears are essential because they form a thin film that coats the front surface of the eye and prevents it from becoming dry. Normally, tears are quickly drained from the eye through a system of channels that lead from the inner corner of the eyelids into the nose. This system of channels is called the lacrimal drainage system.

Illustration: Lacrimal drainage system

Tearing disorders may be due to irritation of the eye or disorder of the drainage system. This can be determined by paying a visit to an ophthalmologist who will perform simple tests to determine the cause.

You may experience “wet eyes”, which is particularly disturbing when reading or looking down. In more severe cases, tears may even roll down the cheeks. If the blockage is not resolved, stagnation of tears within the tear ducts can lead to serious infection with mucopurulent discharge.

Illustration: Infection within the lacrimal sac

What causes excessive tearing?
Any emotional stress or eye irritation will cause an overproduction of tears. Blockage of the lacrimal drainage system is an important cause of excessive tearing. This tends to occur in older people and the cause of the blockage is usually due to changes of the nasolacrimal duct.

If you have an acute infection of the lacrimal drainage system, this must be treated with antibiotics. The next step is to determine the degree of obstruction and the site of blockage. This is done in the clinic by flushing the tear ducts with saline. Flushing the system might relieve the symptoms temporarily, but they often recur.

Surgery is necessary to treat those with severe obstruction of the tear ducts, or those who have repeated infections of the system. The operation required is called dacryocystorhinostomy (DCR), when a new channel is created to allow tears to drain into the nose again. Specific operations depend on the site of obstruction.

Tearing in a newborn baby
A newborn may have a “wet” eye at one to two weeks of age. Occasionally, there may be associated mucopurulent discharge. This is due to a membrane blocking the drainage system of tears into the nose. This blockage usually opens spontaneously within four to six weeks after birth.

Massaging the inner corner of the eyelids over the site of the lacrimal sac may hasten the opening of the blockage. However, if the tearing persists despite the massage, flushing and probing of the drainage system can be done to perforate the membranous blockage.

This procedure is usually performed when the child is less than one year old. The flushing and probing can be repeated if the tearing persists. Persistent tearing despite these measures would require surgical procedures to relieve the obstruction.