Epiphora, or tear tearing, is the term used to describe a greatly increased flow of tears in the eye. Strictly speaking, this is more of a symptom than a disease itself, as epiphora accompanies numerous eye diseases.
What is epiphora?
If there is a disturbance anywhere in the eye within this drainage system, it often results in excessive tear formation, or lacrimation. A healthy eye is moistened, cleaned, by means of tear formation and distribution at regular intervals. In addition, it is protected against the penetration of foreign bodies such as dust as well as the infestation with pathogens. With each blink, a tear film is distributed over the eyes and ensures unobstructed and clear vision. The tears enter the eye through small glands below the upper eyelid, the lacrimal glands. They then flow out again via the tear ducts, tiny, point-like openings in the corner of the eyelid next to the nose. If there are disturbances at any point within this drainage system, this often results in excessive tear formation, tear tearing. Vision becomes blurred, skin irritation and swelling (mucocele) can occur, and the eye’s susceptibility to infection increases. Tear tearing may be bilateral or may be confined to only one eye. In principle, epiphora occurs at any age. However, it is most common in infants younger than 12 months and in adults older than 60.
Causes
The most common cause of epiphora is blocked tear ducts. The tears cannot drain and remain in the lacrimal sac. In adults, such a blockage not infrequently occurs as a direct side effect of the aging process. However, inflammation can also promote the onset of epiphora. Triggers for inflammatory processes are, in addition to many bacterial and microorganism types, autoimmune diseases such as vasculitis. Further possible causes are pathological increases in intraocular pressure or severe stress such as facial surgery. Reasons for excessive tear formation that are not caused by blocked tear ducts include irritations in the cornea or weaknesses in the facial muscles (e.g., as a result of a stroke) and the so-called dry eye syndrome. In this condition, the chemical composition of tears is defective and consists mainly of water, which evaporates too quickly to provide effective protection for the eye.
Diseases with this symptom
- House dust allergy
- Animal hair allergy
- Hailstone
- Wegener’s disease
- Hay fever
- Allergy
- Conjunctivitis
- Iritis
- Mold allergy
- Drug allergy
- Contact allergy
- Glaucoma (glaucoma)
Diagnosis and course of the disease
Symptoms of epiphora include severe tearing, frosted eyelashes, or mucopurulent discharge. A physician who notes one or more of these abnormalities will conduct further detailed questioning regarding the symptoms. The patient’s medical history is also relevant here. Generally, epiphora can be readily recognized by a trained medical professional. In further examinations, the physician will then concentrate on determining the disease behind the watering. For this purpose, the patient may also have to be anesthetized. During the examination, for example, tiny tubes are inserted into the tear ducts to determine the exact severity and position of the blockage. Common practice also includes administering fluid into the tear duct to check for outflow and evaporation through the nose. This may also contain a marker that can be used to further specify the location of the blockage on an x-ray, for example. Further progression and selection of appropriate treatment also depend on the disease diagnosed in this way.
Complications
The term epiphora is one that originates from the Greek. Translated into German, it means trickling of tears. This term epiphora is therefore used for various diseases of the eyes in which there is a mismatch between tear production in the lacrimal glands and the outflow of this tear fluid via the draining lacrimal ducts. There are several reasons for this.For example, if the conjunctiva or cornea of the eyes are mechanically irritated, tear tearing almost always occurs. Irritation of the trigeminal nerve also usually causes increased tear production and tear tearing then occurs. Sometimes tear tearing also occurs due to a disease of the paranasal sinuses. Hypertrophy of the lacrimal glands does not cause tear tearing only temporarily. Stenoses of the draining lacrimal ducts can also lead to epiphora due to the resulting drainage disturbance of the lacrimal fluid. Stenoses are narrowings of the lacrimal ducts. These stenoses can be congenital or acquired. Another aspect that can lead to epiphora is malposition of the lacrimal puncta. Also in this case, such malpositions of the eyelids that lead to the malposition of these lacrimal puncta may be present from birth. However, this is not always the case. Degenerative changes of the eyelids also often lead to malposition of the lacrimal puncta and thus to tear tearing. Sometimes even small children suffer from glaucoma. Therefore, tear tearing also occurs in these cases.
When should you go to the doctor?
Behind the term epiphora is an above-average tear flow in the eye. Against dehydration, the eyes are constantly wetted with tear fluid. However, if the tear flow is increased, it is perceived as unpleasant. Epiphora is not only an annoying phenomenon, but can be reason to consult a doctor. If there is no explanation for excessive lacrimation, such as wind, onion cutting and, of course, emotional triggers such as laughing and crying, epiphora may indicate an eye disease. Under no circumstances should those affected by epiphora simply accept their constantly running tears. The possible underlying disease can be of a serious nature and must be clarified by an ophthalmologist. The constant flow of tears can also reduce vision in the long term. If the epiphora is due to a disease requiring treatment, certain environmental factors are often the cause. Here, too, the ophthalmologist with his experience is the ideal contact person. He will give his patient helpful tips on how to prevent excessive lacrimation: for example, make sure the air in the room is not too dry, avoid drafts, limit alcohol consumption, take breaks from the computer or get enough sleep. The ophthalmologist should be consulted first in case of epiphora. In parallel, it should be considered to also consult another specialist such as an internist. It cannot be excluded that the epiphora has another disease as a cause.
Treatment and therapy
Since epiphora is a concomitant of many diseases, it is necessary to obtain a precise diagnosis from a physician before treatment. In general, whenever there is increased tearing over a long period of time, it is urgently recommended to visit an ophthalmologist. If the tearing is caused by a punctal obstruction, the most common type of treatment is opening and washing out the tear spots. This treatment can be done on an outpatient basis and is relatively uncomplicated, but must be repeated several times a year. Accordingly, this procedure cannot be considered as a permanent solution. Blockage of the nasolacrimal duct is often treated with a procedure called dacryocystorhinostomy, or DCR. This involves forming a connection between the lacrimal sac and the interior of the nose via access from the nose. This new opening then allows unobstructed drainage of the tear fluid. DCR is performed without any externally visible incisions and can be performed under anesthesia directly in the ophthalmologist’s office. It is a relatively low-risk treatment method that has an excellent long-term effect in most cases. On the other hand, if dry eye syndrome has been diagnosed, several other measures can provide lasting relief from the symptoms. The most common type of treatment is the administration of artificial tears in the form of eye drops. Such drops are usually available without a prescription and provide rewetting of the eyes. The treatment of dry eyes can also be sustainably supported by a humidifier. More humid ambient air actively counteracts dehydration of the eyes.
Outlook and prognosis
Epiphora leads to increased lacrimation and usually does not occur as an independent disease, but only as an accompanying symptom in other diseases.For this reason, epiphora is also treated causally. The diagnosis of epiphora is usually made without delay and compilations, so that treatment can be given at an early stage. If the epiphora occurs only for a short period of time, it can be treated by the doctor as an outpatient, but it must be repeated several times a year. If it is a permanent problem, causal treatment must be carried out. Usually, the treatment leads to a quick and long-lasting success, so the patient does not need to undergo repeated treatment. In some cases the use of eye drops is necessary. Epiphora can severely limit the daily life of the affected person, so that many activities are no longer possible for the patient. Likewise, the constant tearing of the eyes can lead to accidents or carelessness, increasing the risk of injury. Should epiphora be treated, there is usually no decreased life expectancy.
Prevention
Because epiphora can have multiple causes, specific recommendations for prevention are not possible. In general, the eye should always be kept moist and health stresses low. Consciously blinking the eye regularly and avoiding smoke, wind, and other irritants can significantly minimize the risk of tearing. In particular, people such as those with allergies, nearsightedness and defective vision (especially contact lens wearers) people, as well as those older than 55 who are at increased risk of disease, should see a doctor regularly to have the condition of their eyes checked.
Here’s what you can do yourself
Ephiphora should always be evaluated and treated by an ophthalmologist. However, sufferers can often relieve watery eyes on their own by avoiding drafts, smoke, and hot air (such as from a hair dryer or car blower). In addition, exercise in the fresh air and sufficient sleep help to relieve the eyes and reduce the flow of tears. Regular ventilation and a room climate that is as pleasant as possible help to relieve eye strain and reduce the discomfort of ephiphora. In addition, comprehensive eye hygiene helps: those affected should carefully clean the edges of their eyelids before sleeping and, above all, remove makeup and other residues well. To reduce skin irritation, eyes can be rinsed regularly with clear water. Contact lens wearers can often already reduce tearing by thoroughly and regularly cleaning the lenses. If necessary, changing lenses will also help prevent watery eyes as a result of overuse or irritation. If the ephiphora is caused by another condition or an allergy, the underlying condition must be treated first. As an acute self-help measure, a simple change of sleeping room and increased eye hygiene are recommended.
