A healthy eye is moistened and cleaned at regular intervals by the formation and distribution of tears. It is also protected from the ingress of foreign bodies such as dust and infestation with pathogens. With every blink, a film of tears spreads over the eyes and ensures unobstructed and clear vision. The tears enter the eyes through tubes from small glands below the upper eyelid, the lacrimal glands. These then flow out again via the tear points, tiny, point-like openings in the corner of the eyelid next to the nose.

If there is a problem at any point within this drainage system, this often results in excessive tearing, the tear dribbling . Vision becomes blurred , skin irritation and swelling (mucoceles) can occur, and the eye’s susceptibility to infection increases. Tearing can be bilateral or limited to just one eye. Basically, epiphora occurs at any age. However, it is most common in infants under the age of 12 months and in adults over the age of 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 often occurs as a direct side effect of the aging process. But inflammation can also promote the outbreak of an epiphora. Triggers for inflammatory processes are, in addition to many types of bacteria and microorganisms, autoimmune diseases such as vasculitis . Other possible causes are also pathological increases in intraocular pressure or severe stress such as facial operations.

Possible reasons for excessive tear formation, which is not caused by blocked tear ducts, are irritation in the cornea or weaknesses in the facial muscles (e.g. as a result of a stroke), the so-called dry eye syndrome . In this condition, the chemical composition of the tears is defective and consists mainly of water, which evaporates too quickly to provide effective protection for the eye.

diseases with this symptom

Diagnosis & course of disease

Symptoms of epiphora include profuse tearing, dulled eyelashes, or a mucous discharge. A doctor who finds one or more of these abnormalities will conduct further detailed questioning about the symptoms. The medical history of the patient is also relevant here. In general, epiphora is easily recognized by a trained physician. In further examinations, he will then concentrate on determining the disease behind the tears.

The patient may also need to be anesthetized for this. During the examination, tiny tubes are inserted into the tear ducts to determine the exact severity and location of the blockage. Common practice also includes administering fluid into the tear duct to check nasal drainage and evaporation. It can also contain a marking substance, which can be used to further specify the location of the blockage in an X-ray , for example. The disease diagnosed in this way also depends on the further course and the selection of the appropriate treatment.

complications

The term epiphora is one that comes from the Greek. Translated into German, this means teardrops. This term epiphora is therefore used for various diseases of the eyes, in which there is a disproportion between the production of tears in the lacrimal glands and the drainage of this lacrimal fluid via the lacrimal ducts. There are a number of reasons for this. If, for example, the conjunctiva or the cornea of ​​the eye is mechanically irritated, tears almost always occur.

Irritation of the trigeminal nerve also usually causes increased tear production and tearing then occurs. Sometimes the dripping tears are also due to a disease of the paranasal sinuses . Hypertrophy of the lacrimal glands does not only lead to tear dripping temporarily. Stenosis of the efferent tear ducts can also lead to epiphora due to the resulting obstruction in the drainage of the tear fluid. Stenoses are narrowing of the tear ducts. These narrowings can be congenital or acquired.

Another aspect that can lead to epiphora is misalignment of the tear punctum. In this case, too, such malpositions of the eyelids, which lead to the misalignment of these tear puncta, can already be present from birth. However, this is not always the case. Degenerative changes in the eyelids often lead to a misalignment of the tear punctum and thus to tears. Sometimes young children suffer from glaucoma . In these cases, too, tears trickle down.

When should you go to the doctor?

The term epiphora hides an above-average flow of tears in the eye. To prevent dehydration, the eyes are constantly wetted with tear fluid. However, if the flow of tears is increased, it is perceived as unpleasant. Epiphora is not only an annoying phenomenon, but can be a reason to see a doctor.

If there is no explanation for excessive tearing such as wind, cutting onions and of course emotional triggers such as laughing and crying, epiphora can indicate an eye disorder. Under no circumstances should those affected by Epiphora simply accept their constant tears. The disease that may be behind it 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 caused by a disease that requires 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 this excessive flow of tears: 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 with an epiphora. At the same time, you should consider calling in another specialist, such as an internist . It cannot be ruled out that the epiphora is caused by another disease.

Treatment & Therapy

Since epiphora is a side effect of many diseases, it is necessary to obtain an accurate diagnosis from a doctor before treatment. In general, it is always advisable to go to the ophthalmologist urgently if there is increased tear flow over a longer period of time. When the tearing is from a punctal obstruction, the most common treatment is to open and wash out the puncta.

This treatment can be done on an outpatient basis and is relatively uncomplicated, but must be repeated several times a year. As a result, this procedure cannot be considered as a permanent solution. A blockage of the nasolacrimal duct is often treated with what is known as a dacryocystorhinostomy, or DCR for short. A connection between the lacrimal sac and the inside of the nose is formed via the access from the nose. This new opening then allows the tear fluid to drain freely.

The DCR is carried out without any externally visible incisions and can be carried out under anesthesia directly in the ophthalmologist’s practice. It is a relatively low-risk treatment method that has excellent long-term effects in most cases. If, on the other hand, dry eye syndrome has been diagnosed, the symptoms can be alleviated in the long term by several other measures.

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 ensure that the eyes are moistened again. The treatment of dry eyes can also be sustainably supported by an air humidifier. Humid ambient air actively counteracts dehydration of the eyes.

Outlook & Forecast

The epiphora leads to an increased flow of tears and usually does not occur as an independent disease, but only as an accompanying symptom of other diseases. For this reason, the epiphora is also treated causally. The diagnosis of epiphora is usually made without delay and compilations, so that treatment can take place at an early stage.

If the epiphora only occurs for a short time, outpatient treatment can be carried out by the doctor, which must be repeated several times a year. If this is a permanent problem, causal treatment must be carried out. As a rule, the treatment leads to a quick and long-lasting success, so that the patient does not have to undergo repeated treatment. In some cases, the use of eye drops is necessary.

The epiphora can severely restrict the everyday life of the person concerned, so that many activities are no longer possible for the patient. Likewise, constant tearing of the eyes can lead to accidents or carelessness, increasing the risk of injury. If the epiphora is treated, there is usually no reduced life expectancy.

prevention

Since epiphora can have a variety of causes, specific recommendations for prevention are not possible. In general, the eye should always be moist and health risks should be kept low. Conscious, regular blinking of the eye and avoidance of smoke, wind and other irritations can significantly minimize the risk of tears dripping.

In particular, people such as people with allergies , nearsightedness and ametropia (especially people who wear contact lenses), as well as those who are older than 55 years and are therefore at increased risk of illness, should see a doctor regularly to have the condition of their eyes checked.

You can do that yourself

An Ephiphora should always be clarified and treated by an ophthalmologist . However, those affected can often relieve the watery eyes themselves by avoiding drafts, smoke and hot air (e.g. from the 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 protect the eyes and reduce the symptoms of the Ephiphora.

Comprehensive eye hygiene also helps: those affected should carefully clean the edges of their eyelids before going to sleep and, above all, remove make-up and other residues well. To reduce skin irritation, the eyes can be rinsed regularly with clear water. Contact lens wearers can often reduce tears by thoroughly and regularly cleaning the lenses. If necessary, a lens change also helps to avoid watery eyes as a result of overload or irritation.

If the Ephiphora is based on another ailment or an allergy, the respective underlying disease must first be treated. As an acute self-help measure, a simple change of bedroom and increased eye hygiene is recommended.