The lacrimal gland produces tears continuously and when you blink they are drawn into two small holes, each called a punctum (in the inner corner of your eyelids). There is one punctum in the upper and lower eyelid, which lead into small tubes known as the canaliculi, which in turn drain into the lacrimal sac. This lies between the corner of your eye and your nose and has a duct at the bottom, which drains into your nose, called the Naso Lacrimal Duct (NLD).
The normal system does not have much spare capacity (that is why we “cry”) and the narrow drainage channel becomes even narrower with age, especially if there has been nose or sinus disease.
A watery eye can be present from birth, due to normal aging changes or associated with naso lacrimal system conditions like punctual / canalicular / NLD stenosis (narrowing) or block.
An eye can water due to multiple other factors like allergy (ocular or rhino-sinusitis), eyelid laxity (due to excessive rubbing and or aging), blepharitis, and paradoxically secondary to a dry eye.
The most common symptom of having a plugged or infected tear drain is excessive watering, mucous discharge, eye irritation and painful swelling in the inner corner of your eyelid.
A skillful history and examination, to include syringing of the tear ducts and endoscopic examination of the nasal cavity can pinpoint the cause of a watery eye. Occasionally additional radiographic tests such as DCG (dacrocystogram) or DSG (dacroscintillogram) may be required.
What are the treatments for watery eyes?
Your surgeon may recommend a number of treatments based on the analysis of your symptoms.
It can be as simple as applying warm compresses and antibiotics, using lubricants or using anti-allergy drops and a nasal spray.
Surgical options can include surgery to tighten the eyelids (this can improve the position of eyelids, but in some cases cannot guarantee a “cure” of the watery eye).
If the punctum is stenosed, a surgical procedure to open the mouth of the tear duct can be effective in controlling the excessive watering. If the drainage channels on the inside of your eye (canaliculi) are narrowed but not completely blocked, it may be possible to use a probe to widen them. If the canaliculi are completely blocked, an operation involving a small glass tube (called Lester Jones Tube) being inserted to bypass the blockage and drain the tears, may be required.
If there is stenosis / block of the canaliculus or NLD, treatment options include a Dacrocystorhinostomy (DCR) operation or using a balloon lacrimal stent.
Treating watering eyes in babies
In babies, watering eyes often resolves without the need for treatment by the time the baby is a year old.
Massaging the tear ducts may help to dislodge tears that have collected in the upper part of your baby’s tear duct, as well as encouraging the tear duct to develop. This can be done by applying light pressure with your first (index) finger and massaging from the corner of your baby’s eye towards their nose. Repeat the massage several times a day for a couple of months. Before massaging, wash your hands.
You can also soak a cloth with warm water and hold it against your baby’s eye. This may encourage the tears to drain. If your baby has an eye infection (conjunctivitis), this may need to be treated with antibiotic eye drops.
If the tear duct does not open, it may be possible for your baby to have a procedure where a probe is used to open their tear duct. This will be carried out under general anaesthetic.
Probing is not usually necessary because in 9 out of 10 cases, the tear duct opens by itself. However, a probe can be used if your child has repeated infections caused by the blocked tear duct and he or she is over a year old. Very occasionally a DCR operation is required.