Epiphoria (Watering Eyes)

Epiphoria is caused by:

• Overproduction of tears or
• Inadequate/ blocked drainage¹

Overproduction of tears:

• Is, rarely, the presenting feature in infants with congenital glaucoma
• Corneal trauma e.g. abrasion, foreign body, ingrowing eye lash
• Conjunctivitis
• Iritis
• Acute glaucoma

Impaired drainage:

• Puncta (drainage points) can be malpositioned, often in association with ectropion.
• Closure of puncta (cannot be seen without magnifying glass).
• Blockage of nasolacrimal duct; in adults it is caused by either acute or chronic dacryocystitis. Duct may not open naturally in young children.

• Excess tears and continually watering eyes.
• Acute dacryocystitis is associated with painful swelling and redness around the lacrimal sac, with a purulent discharge.
• In the chronic form there is just epiphoria and a discharge.

• Daily massage of lacrimal sac in children with non-patent drainage.
• Chloramphenicol for recurrent conjunctivitis in young children. Systemic antibiotics for dacryocystitis, but requires relief of obstruction to prevent recurrence. Chronic dacryocystitis caused by congenital nasolacrimal duct obstruction can be treated with Ofloxacin topical drops.² MRSA has been reported to occur in dacryocystitis in both adult and paediatric populations in association with chronic dacryocystitis, secondary to congenital nasolacrimal duct obstruction in an infant.³
• Punctal stenosis - surgical opening or dilatation.
• Blockage of nasolacrimal duct - initially syringing and if this is unsuccessful dacryocystorhinostomy where a fistula is created from the lacrimal sac to the nose. This can be performed endoscopically through the nose or as major surgery under general anaesthesia.⁴
• Nasolacrimal intubation (particularly for patients with canalicular duct obstruction) has been shown to give good long-term control.⁵