DEFINITION OF WATERING EYES :

• The watering eyes is characterized by the overflow of tears from the conjuctival sac.
• Two of the conditions may lead to watering eyes.
• Firstly, Watering eyes may be due to hypersecretion of the tears (Hyperlacrimation).
• Secondly, Watering eyes may result due to inadequate drainage of the normally secreted tears.
• Moreover, the above condition is also called Epiphora.

ETIOLOGY OF WATERING EYES :

A. CAUSES OF HYPERLACRIMATION

• Primary hyperlacrimation
• Reflex hyperlacrimation
• Central lacrimation

PRIMARY HYPERLACRIMATION

• It is a rare condition.
• Moreover it occurs due to direct stimulation of the lacrimal gland.
• Most importantly it occurs in the early stages of lacrimal gland tumors and cysts
• This condition can also result from the effect of strong parasympathomimetic drugs.

REFLEX HYPERLACRIMATION

• Reflex hyperlacrimation results from stimulation of sensory branches of fifth nerve.
• Moreover this reflex stimulation may be the result of irritation of cornea or conjuctiva.
• Further the above conditions may be the result of multitude of conditions which include;
• Affections of the lid, conjuctiva, cornea, sclera and also uveal tissue.
• Acute glaucomas
• Endophthalmitis and also Panophthalmitis
• Orbital cellulitis

CENTRAL LACRIMATION

• The other name for central lacrimation is Psychial lacrimation.
• The exact area concerned with the Psychial lacrimation is not known.
• Moreover they occur in conditions like emotional states, voluntary lacrimation and hysterical lacrimation.

B. CAUSES OF EPIPHORA

• Physiological cause
• And also Mechanical obstruction

PHYSIOLOGICAL CAUSE OF WATERING EYES :

• It is lacrimal pump failure due to lower lid laxity or weakness of orbicularis muscle.

MECHANICAL OBSTRUCTION THAT LEADS TO WATERING EYES :

• The chances of location of obstruction is at the level of Punctum, Canaliculus, Lacrimal sac or Nasolacrimal duct.
• Punctal obstruction :
• There may be congenital absence of Puncta.
• Obstruction may also be due to cicatrical closure following injuries, burns or infections.
• Rarely, a small foreign body, concretion or cilia may also block the punctum.
• Prolonged medications which includes drugs like idoxuridine and pilocarpine is also associated with punctal stenosis.
• Treatment :
• Punctal dilatation with the help of Nettleship punctum dilator in mils cases.
• Moreover punctoplasty by three snip operation is also a choice of treatment, if dilatation does’nt help.
• Canalicular obstruction :
• Canalicular obstruction may be due to Canaliculitis 
• And also it may be due to canalicular strictures.
• Canaliculitis :
• The commenest cause of canaliculitis is actinomycetes.
• Moreover it is characterized by presence of concretions.(Sulfur granules)
• Treatment :
• Antibiotics can be given.
• Moreover manual removal of concretions is rarely effective.
• Moreover posterior canaliculectomy with linear incision on the conjuctival side stands effective.
• Canalicular strictures :
• Canalicular strictures may be due to trauma or post inflammatory or idiopathic conditions.
• Treatment :
• Canalicular triphening and also with Canalicular intubation with Mini Monoka may be useful.
• Canaliculodacrocystorhinostomy.
• That is insertion of Lester Jones tube from inner canthus into the nose.
• Moreover it is done through a DCR opening that stands useful.

 

Clinical evaluation of a case of ‘Watering eye’ :

• Firstly, Ocular examination with diffuse illumination using magnification.
• Secondly, Regurgitation test.
• Thirdly, Fluorescein dye disappearance test
• Lacrimal syringing test
• And also Jones dye test
• Dacryocystography and also
• Finally, Radinucleotide dacrocystography

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