Having watery eyes is a very common sensation, especially in the winter period due to the cold or because of a cold or when we have suffered a small irritative trauma such as an annoying speck of dust or sand on the surface of the eye. Tearing of the eyes
( a condition called epiphora in scientific terms ) is an annoying and unpleasant symptom, but in most cases it is a limited episode that tends to disappear within a few minutes or a few hours depending on the triggering cause.
Similarly also the reverse situation, ie when you have dry eyes, in most cases and due to transitory conditions due to weather, wind or the use of contact lenses.
This does not mean that there may also be pathological pictures behind the tear alteration and, as we will see later, some of them can be serious but in these cases the symptoms go well beyond the presence of a few more tears or a simple dry eye.

What are tears
Tears are the product secreted by the tear glands with the purpose of protecting, moisturizing, cleaning and nourishing the surface of the eye. They consist mainly of water to which electrolytes , amino acids, proteins and lipids are added.
How the lacrimal system works
The lacrimal system is that set of organs responsible for the production and secretion of tears .
The production is operated by the lacrimal glands, in which, for each eye, a main one is identified located in the lacrimal dimple of the frontal bone (ie in the orbit) and of the accessory glands. While lacrimation is allowed by the lacrimal ducts which lead the tear fluid into the nasal choanas.
In addition to these two phases is added that of the distribution of tears on the surface of the eye by the action of the eyelids during blinking (natural reflex of blinking with a frequency of 6-8 openings-closings per minute).
When to see a doctor

We have seen that in most cases, excessive tearing or lack of tearing is related to environmental causes or small irritative phenomena.
In these cases, just go to the pharmacy and mainly the use of a decongestant eye drops will be recommended. If, on the other hand, the complaints are prolonged and are associated with pain, swelling and redness, it is recommended to undergo a medical examination promptly.
To learn more about the characteristics of artificial tearsI suggest you read our in-depth guide on this. Artificial tears, in fact, represent an effective remedy in cases of dry eyes or are used to give relief to the eyes of those who wear contact lenses.
Let’s now analyze the most common causes of watery eyes .

What are the most common causes of watery eyes
In most cases, as seen above, a watery eye or the sensation of dry eye are episodes limited in time and due to transient causes that once resolved leave no trace or negative impact on vision.
Very often colds and colds cause vasoconstriction and this does not allow the normal flow of tears through the tear ducts and the eyes will tend to expel the tear film through the tears.
The sensation of dry eyes can be related to the use of contact lenses, to the presence of wind, dry climate and heated environment, all conditions that facilitate the evaporation of the tear film that protects the surface of the eye.
Sometimes to cause low tear production and certain medications (antihistamines, diuretics, hormones and immunosuppressants).
The pathological processes affecting the lacrimal apparatus are divided into dacryoadenopathies, when they involve the structures responsible for the production of tears (main and accessory lacrimal gland), canaliculopathies and dacryocystopathies when they involve the organs responsible for the secretion of tear fluid.
Let’s see below what phenomena affect these structures:

  • Congenital anomalies : in these cases during the fetal life the individual does not develop an efficient lacrimal gland, therefore he shows the absence of lacrimation;
  • Inflammations : this is one of the most common and most varied occurrences of tearing eyes . Inflammation can occur acute, chronic, unilateral, bilateral and often derives from diseases such as mononucleosis, mumps, conjunctivitis, but also following trauma. Generally, the therapy consists in the administration of anti-inflammatories and antibiotics that go to counter the pathogen involved. The prognosis is positive and usually within 10-15 days the situation tends to regress and resolve. The situation changes when it comes to chronic inflammation caused by viruses or tuberculosis, in these cases, in fact, there is a real risk that the inflammation extends to the optic nerve causing important repercussions on the visual capacity;
  • Among the other most common pathologies, mucocele is identified , a cyst that can be of both traumatic, inflammatory and congenital origin. This formation obstructs the lacrimal ducts due to excessive compression;
  • Atrophy : mainly concerns elderly subjects in which, due to the physiological reduction of the activity of the tear glands, there is a lower production of tear film . There are also idiopathic forms that affect young subjects suffering from Sjogren’s Syndrome or other autoimmune diseases;
  • Trauma : quite common cause as for inflammation. It is frequent that following a fracture of the temporal bone there is a compression of the lacrimal gland, if not its laceration, bringing the organ to a reduced activity;
  • Tumors : the growth of a tumor mass can compress the organs contained in the eye socket, including the lacrimal gland and the lacrimal ducts, inhibiting or stopping their activities. The tumor of the orbit is often accompanied by a rather evident symptom, the exophthalmos, that is the push of the eyeball towards the outside of the orbit. The eye appears very protruding and generally leads the patient to be examined quickly. We therefore strongly urge you not to underestimate this type of manifestation.

Let’s now go into the main ways of diagnosing excessive tearing of the eyes .

Eye tearing: the diagnosis
In the event of lacrimation disorders , the medical examination investigates all the aspects that may be at the origin of the phenomenon, and this through a thorough medical history, an objective examination and any more specific examinations in relation to diagnostic suspicions based on the information collected.
During the medical history and physical examination, the doctor ascertains the manifestations that led the patient to a visit and the symptoms that accompany the lacrimation disorders .
It is important to evaluate the presence of itching, redness, sudden onset of vision disturbances, pain, secretions, swelling and photophobia.
We then proceed with the administration of tests useful in order to evaluate the functionality of the organs responsible for tear secretion and excretion, let’s see some of the most used.

Schirmer’s test: it is a non-invasive and painless quantitative tear test that is divided into two stages:

  • Schirmer 1 test: performed before any other investigation and maneuver on the eyeball to minimize reflex tearing . The test is carried out by applying a piece of absorbent and graph paper directly in contact with the lateral extremity of the lower eyelid. After 5 minutes from the application of the absorbent paper, the wet part of the tear filter is measured. If the moistened part is equal to or greater than 10 mm (therefore 1 cm), the patient’s lacrimation falls within the normal parameters, if instead the moistened part is less than 10 mm there is a situation of hyposecretion, therefore the subject produces less film tear of the norm and in these cases we proceed by carrying out the Schirmer type 2 test;
  • Schirmer 2 test: the test is very similar to the previous one, but this time we go to stimulate the reflex mechanism of tearing by introducing a piece of cotton, or a swab inside the nostril and moving it in contact with the mucous membrane of the nose to 1 or 2 minutes. If even after carrying out this stimulation the lacrimation is still absent, this indicates inactivity of the lacrimal gland.

Staining test: this method evaluates the functionality of the lacrimal ducts and to do this, a dye instilled in the eye is used. As we have seen previously, the tear film is drained into the nasal meatus, therefore by inserting a swab into the nostril it is possible to observe whether the dye has passed correctly through the tear ducts. If the swab is colored the passages are free, if instead the swab remains white it indicates a blockage or obstruction of the nasal passages. In this case it is possible to wash with a cannula needle using a physiological solution.
The same examination can also be carried out with more technological means such as optical fibers.
What therapies we have available

What therapies we have available
Given the extreme delicacy of everything that concerns the ophthalmological context, and therefore everything that concerns the eye, orbit, lacrimal apparatus and nerve pathways, the maximum promptness of intervention is recommended by contacting your doctor and in case of need for a visit. specialist in ophthalmology.
It is a set of extremely complex and delicate organs and structures and an incorrect treatment can irreversibly compromise the sight, therefore it is strongly warned against undertaking initiatives based on articles found on the internet.
Having clarified this point, we move on to illustrate the main therapeutic strategies adopted as a treatment in case of pathologies affecting the lacrimal apparatus.

In case of dry eye:

  • Artificial tears: used in patients who have impaired function of the tear glands. Generally they should be applied several times during the day according to the medical indications provided, establishing a correct hydration of the ocular surface and avoiding damage to the cornea (given the defensive function performed by the tear film);
  • Special contact lenses that allow to keep the corneal surface moistened;
  • Sometimes a surgical intervention is necessary which partially obstructs the lacrimal ducts, allowing a slower flow and therefore the tears to remain sufficiently on the eye;
  • It is suggested to maintain a correct humidity of the rooms, using vaporizers and in the winter months keeping the heating at lower temperatures than usual;
  • As behavioral strategies it is suggested to drink plenty of fluids and to prefer a diet rich in fruit and vegetables.

In case of wet eye:
The most suitable therapy is to be related to the cause of excessive tearing of the eyes . You can use decongestant eye drops, antibiotics if the cause is due to bacterial infections, anti-inflammatory or antihistamine if the cause is due to an allergy.
If the tearing of the eyes is due to the presence of a foreign body, it is removed, and in some cases the most adequate treatment is of a surgical nature. In any case, the specialist doctor must recommend the correct therapy to follow.
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