WATERY EYE

Tears are formed by the lacrimal gland, which lies beneath the outer part of the upper lid, and by cells in the conjunctival surface of the eye.

This is a very common symptom for which there are a wide variety of causes. In general the problem results either from an over production of tears or reduced drainage of tears.

CAUSES OF OVERPRODUCTION OF TEARS

Anything that irritates the eye, such as a foreign body or a scratch to the surface, will result in epiphora. The watering is a protective mechanism to help clear debris away from the eye. Watering also occurs in emotive states or as a response to bright lights.

The most common cause is blepharitis. This condition occurs when there is inflammation in the eyelid glands and sometimes debris accumulates along the lid margin (edge of the eye lid), resulting in irritation. This can be treated with regular lid margin cleansing and may require courses of topical or oral antibiotics.

DRAINAGE OF TEARS

Tears are drained from the eye by narrow passages (canaliculi) that begin in the inner corner of the eyelids. These passages drain into a tear sac in the inner corner of the eye (lacrimal sac) and pass down into the nose via a duct (nasolacrimal duct).

OBSTRUCTION TO TEAR DRAINAGE CHILDREN

Epiphora is a very common problem, occurring in up to 30% of infants. There is a membrane at the lower end of the nasolacrimal duct, which will open on its own in over 90% of cases by the age of 12 months. If symptoms persist when the child is one year old, the condition can be cured in 95% of cases by passing a probe along the passageways under a brief general anaesthetic. Occasionally, this is performed earlier if the child has particularly troublesome symptoms.

However, there is a greater risk of uveitis in people with other inflammatory or autoimmune problems such as TB, inflammatory bowel disease, inflammatory arthritis and psoriasis.

A common cause is HLA B27- related uveitis. HLA-B27 is a gene that some people are born with that can predispose them to developing uveitis later in life.

In some cases uveitis is caused by an infection. Your ophthalmologist may request investigations to check for an underlying cause.

ADULTS

Watering may occur at any age and results from a gradual narrowing of the upper end of the nasolacrimal duct, generally from chronic inflammation. Syringing the tear ducts may give temporary relief, but this is mainly used to aid in diagnosis. The treatment is to make a new passageway for tears to flow into the nose, bypassing the blocked duct. This is a more major procedure but is generally performed under local anaesthesia with sedation.

TREATMENT

There is no known cure for uveitis, but in most cases it can be treated very effectively with a course of steroid eye drops over four to six weeks.

Cases of intermediate or panuveitis usually require additional treatment as eye drops cannot penetrate well into the back of the eye.

Depending on the severity of the disease, your doctor may recommend oral steroid therapy or steroid injections around the eye. In very rare cases other immunosuppressant medications are required.