Harvard Health

Q. I'm 63 and have tears running down my face at odd times. Most of the information I've found on the Internet is about infants with blocked tear ducts. Can you provide some information about tearing in adults?

A. Watery eyes are a common problem for adults, and there's often an effective way of treating them.

First, a little background. Your lacrimal glands, which are located above the eye at the edge of the eye socket, are continually making small amounts of tears at a steady rate (see the illustration). Blinking helps spread the moisture over the front of your eyes, creating a clear, protective film that keeps the eye from getting irritated by dust and dirt and helps fend off infections. But once the fluid has served its purpose, or if there's too much of it, an ingenious drainage system gets rid of the excess. Tiny tear ducts connect the inside corners of the eyes to the inside of the nose. Blinking helps pump the fluid away from the eyes, down the duct, and into the nose. Watery, or teary, eyes develop when more fluid is produced than can be drained away; essentially, it's a plumbing problem.

In my experience, people who seek medical attention for watery eyes usually have one of four problems. Sometimes the openings to the tear ducts close up, even if the ducts themselves are open. Ophthalmologists call this punctal stenosis. Think about the drain in your sink. Even if the drainpipe is OK, if the drain opening is too small, water will have a hard time getting into the pipe and will back up. Punctal stenosis usually can be fixed in a matter of minutes with a procedure that requires only local anesthetic.

Often, though, the problem is a blockage farther down the tear duct -- in the pipe itself. Tear duct blockages can be a side effect of some of the drugs used to treat cancer, such as docetaxel, a commonly used treatment for breast cancer. A facial injury can also cause the tear duct to become blocked. However, most blockages of the tear duct don't have an identifiable reason -- it just happens. Usually this occurs in women after menopause.

Doctors have been performing operations to open blocked ducts since the mid-1800s, so this is familiar ophthalmic territory. On the other hand, it's not a minor procedure: it involves general anesthesia and requires cutting into the bone. There are variations on the theme, but the basic notion is to repair the drainage system by creating a little passageway around the blockage.

A third reason for watery eyes is, ironically, dry eyes. If the tear gland doesn't provide enough moisture on a constant basis, the eyes dry out, become irritated, and cause the gland to overcompensate, producing a gush of tears that floods the eye. Many conditions cause dry eyes, and sometimes the underlying condition itself can be treated. But often it's a matter of treating the dry eyes themselves.

The over-the-counter "artificial tears" products often work quite well. But if they don't, one alternative is an eye drop version of cyclosporine, the immunosuppressive drug that transplant recipients take to reduce the chances that the new organ will be rejected. In the eye, cyclosporine has a powerful anti-inflammatory effect that can help cases of dry eye that aren't amenable to other treatments.

Finally, people can develop a watery eye if the lower eyelid is lax and droops away from the eye. When this happens, the tears are not pumped into the tear duct, but instead accumulate on the surface of the eye. This condition is easily fixed by tightening the eyelids surgically. Eyelid surgery has become popular for cosmetic reasons, but it's an option to consider as a medical treatment if your eyelids are so lax that you are excessively teary.

Most causes of watery eyes can be fixed. Talk with your ophthalmologist. He or she will likely refer you to an oculoplastic specialist -- an ophthalmologist who has done additional training in eyelid and tear duct surgery. That doctor will be able to test for the things that cause watery eyes and choose a treatment plan based on the cause.

Mark Hatton, M.D., Ophthalmic Consultants of Boston, Mass.

 

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