Tearing - increased

Alternative names
Epiphora; Increased tearing

Definition
Increased tearing is the excessive production of tears in one or both eyes.

Considerations

Tears are necessary for the normal lubrication of the eye and to wash away particles and foreign bodies. Excessive tear production or improper drainage of the tear duct results in watery eyes. Irritation, infection, and inward-growing eyelashes can also cause watery eyes. An infection or blockage of the tear duct can also cause excessive watering of the eyes when tears do not drain normally through the nose.

Increased tearing is sometimes accompanied by yawning, vomiting, laughing, and eyestrain.

Oddly enough, one of the most common causes of tear is dry eyes. Drying causes the eyes to become uncomfortable which stimulates the body to produce too many tears. One of the main evaluations for tearing, is to check if the eyes are too dry!

Common Causes

     
  • dry eyes  
  • clogged tear duct  
  • environmental irritants, including smog or chemicals in the air, exposure to hot wind, strong light, blowing dust, or airborne allergens  
  • blepharitis - dandruff like substance on the eyelids that disrupts tears  
  • conjunctivitis (often accompanied by itching or redness)  
  • foreign bodies and abrasions  
  • allergy to mold, dander, dust  
  • eyelid turning inward or outward

Home Care

Consider the cause of the tearing. If the eyes feel dry and burn and then begin to tear, consider artificial tears before tearing occurs. This prevents the reflex tearing.

If the eyes are itchy and uncomfortable consider allergy as a cause. Occasionally topical and over the counter antihistamines can be useful. If the eyes have a mucous discharge or are red, consider a blocked tear duct or eyelid problem.

Call your health care provider if

Tearing is not an emergency, but can be very annoying and usually can be treated.

     
  • prolonged unexplained tearing  
  • associated with pain in the eye  
  • associated with tenderness around the nose or a sinuses  
  • red eyes, excess discharge

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting increased tearing may include:

     
  • time pattern       o When did it begin?       o Is it the first occurrence?       o Does it occur all the time or off and on?       o Is there a pattern to the occurrences?  
  • quality       o Is the vision affected?       o Are corrective lenses worn or needed?       o Is the increased tearing related to emotional responses?       o Is the tearing accompanied by pain? Stinging? Itching?       o Is the fluid clear?       o Are the eyes red or swollen?       o Is drainage or crusting present on awakening?  
  • location       o Does increased tearing affect both eyes?       o If so, are they affected equally?  
  • aggravating factors       o What seems to cause or increase the tearing?       o What medications are being taken?       o Are there allergies?       o Is there frequent exposure to wind, dust, chemicals, sun, or light?       o Have there been recent injuries to the eye(s)?  
  • relieving factors       o What seems to help reduce the tearing?       o Have eye solutions been tried?  
  • other       o What other symptoms are also present?       o Is there any loss of vision?       o Have there been changes in vision?       o Is there a headache?       o Is there nasal congestion or a runny nose?       o Are there joint aches or muscle aches?       o Has anyone else had similar symptoms recently?

The physical examination may include a detailed eye examination.

Diagnostic tests that may be performed are:

     
  • culture and sensitivity testing of tear specimen  
  • Schirmer’s test

Intervention:

Once the symptoms are explained, the cause is usually clear. Treatment can include artificial tears, topical antihistamines antibiotics or even surgery.

If a blockage of the tear system is possible, a probe is inserted into the tear drainage system. This is painless. If a blockage is present surgery is usually necessary to correct the problem. Improper eyelid position can also be fixed with minor surgery.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.