Epiphora is an eye disease that causes the patient to experience watery eyes. The condition is usually a result of excessive production of aqueous (watery) tears or improper function or blockage of the tear drainage.

Despite the excess of tears, epiphora can be symptomatic of underlying dry eye disease. Epiphora is not harmful and is readily treatable, but it can be annoying and can cause some discomfort. It must be noted that tears actually play an important role in
lubricating the eyes. Because of tears, foreign bodies that may enter your eyes are easily removed. They are also responsible for maintaining ocular comfort, hydrating the cornea (front surface of your eye) and fighting infection.  It is only when there is increased or excess tearing that a problem arises and it needs to be managed.

Symptoms of Epiphora

This eye disease often afflicts people who live in windy or cold places, where the ocular surface becomes irritated and produces excess tears. A foreign object (such as a grain of sand or a small insect) lodging the eye may also lead to this condition, as can a blockage in the drainage duct that leads away from the corner of your eyelid.

You should consult your eye specialist when the following happens as it may be a sign of this eye disease:

1.    Excessive and / or painful tearing that persists
2.    Excessive mucous / discharge along with the watery tears
4.    Persistent red eyes
5.    Tender feeling around the nose or sinus area

Causes of Epiphora

This eye disease may be caused by the following:

1. Abrasion to the ocular surface
2. Advancing age (eyelids can lose tone and hang away from the eyeball, preventing good tear drainage)
3. Environmental irritants, like smog, chemicals, dust, cold, wind and allergens such as moulds and pollens
4. Blocked tear drainage, in which the opening in the drainage is either narrow or displaced (this is common in infants)
5. Conjunctivitis, in which the ocular surface becomes inflamed
6. Dry eyes, in which the patient produces excess tears to address the dryness in the eyes
7. Blepharitis, in which dandruff-like scales from the eyelids enter the eyes
8. Eyelashes growing inward
9. Eyelids turning inward or outward
10. Foreign bodies entering the eye
11. Polyps in the nose

Diagnosing and Treating Epiphora

Epiphora is an ocular surface disease and is best treated by an optometrist or ophthalmologist who specialises in the management of ocular surface disease. They will usually conduct the following steps:

1. Thoroughly discuss your ocular and medical history
2. Carry out a number of diagnostic tests on your tear quality and quantity (including a phenyl red thread test)
3. Physically examine your eyes for a blockage in the tear drainage ducts (they may place a drop of dye in your eye, then see if it makes its way into your nose).

This eye disease may resolve by itself even without outside intervention.  If the problem does not go away, however, seek the advice of a dry eye specialist as they would be in the best position to recommend treatment alternatives and address the underlying cause.

Home therapies

These are best carried out under instructions from your eye care practitioner, as it is important to understand the cause of the epiphora before treating or you could make things worse.

1. Apply a warm compress on the affected eye. This is best done with a proprietary product such as a Bruder Pack.
2. Make use of eye drops. Contrary to what you would think, applying quality lubricating drops can actually ease the epiphora. Those with dry eye syndrome may also use artificial tears to relieve the dryness.
3. If in windy or cold environments, wear appropriate protective sunglasses to protect you from debris and particles floating around in the air. Consult your optometrist on what kind of protective sunglasses are recommended.

Your optometrist may also prescribe medical or surgical therapies

1. If the problem is in the drainage portion, your optometrist may
   recommend surgery and refer you. This is a fast and safe option that will take care of
   the problem immediately. This procedure needs to be performed by an
   ophthalmologist that has a sub-specialty in oculoplastics and involves flushing out or clearing the tear ducts so they can work effectively again.
2. Antibiotic drops may be indicated if there is an infection at the root of the problem.
3. Antihistamines may also used for epiphora caused by allergies.

 At The Eye Practice, we see all sorts of manifestations of ocular surface disease – including epiphora – on a weekly basis. Don’t put up with the discomfort any longer. Make an appointment today and let us help you get your life back.

The post was originally published in The Eye Practice blog in December 2012 and has been updated for accuracy and relevance.