What is Epiphora
Definition : is the condition of the eye or both eyes characterized with an abnormal overflow of tears as a result of insufficient tear film drainage in the eye. The tears overflow to the face instead of draining in the nasolacrimal system.
The condition of epiphora is also known as watery eye which affects mostly infants of age 12 months and below. It can also affect adults over 60 years of age.
Picture 1: watery eyes in the infant casued due to epiphora
image source: kinglasik.com
Tears are important to the eyes in keeping it moist and healthy. It is a composition of water, salt, protein and mucus. Tears also protect the eyes by washing away the dirt from the surface of the eyes that can cause irritation and other certain conditions.image source: kinglasik.com
Lacrimal glands are tiny tubes in the eyes through which the tears flow. They drain from the tiny opening of each eye known as the puncta. The puncta can be found on the upper and lower lids of each eyes and from this the tears drain into small tubes called canaliculi or lacrimal ducts located in the inner corner of the eyelids.
picture 2: tears storing in the lacrimal sac
image source: slidesharecdn.com
image source: slidesharecdn.com
From the canaliculi, the tears will pass through a small pouch beneath the inner corner of each eye from where it gather and drain through the nasolacrimal duct. The tears then empty to the back of the throat or nostrils.
Causes
Epiphora is a result of an obstruction in the tear flow tract where the obstruction may occur in one of its anatomical part. The obstruction may occur in ectropion, punctal, canalicular or nasolacrimal duct. There are two main causes of epiphora and these are:Blockage in the tear ducts
Epiphora may be a result of blocked tear ducts that may have been underdeveloped from the time of birth. This condition usually resolves a few weeks as soon as the ducts are developed.It is common for babies to be born with obstructed lacrimal ducts but epiphora goes away when the ducts developed while babies are also growing and developing.
Picutre 3: Blockage in the lacrimal ducts
image source: adam.com
image source: adam.com
In adults, epiphora is due to obstruction in the punctum as a result of normal aging process and could also be brought about by infection or trauma. Epiphora in adults is also age-related to some degree of atrophy in the mucus membrane of the ducts.
The blockage in the tear ducts may also be from scar of wounds that healed. The wound or damage may be due to trauma in the nasolacrimal ducts system as a result of trauma in the facial structures and soft tissues involving the nose or the eyelid.
Picture 4: Swelling in the tear ducts due to the blockage
image source: warwareyegroup.com
image source: warwareyegroup.com
Swelling of the nasolacrimal ducts block the normal drainage of the tears causing it to build up and overflow. The swelling may be a result of infection such as conjunctivochalasis and rhinitis.
Over production of tears
The eyes produce more tears when it is irritated. The tears flow when irritated to facilitate washing away of the irritants. The irritants that can induce over flow of tears include:- Exposure to chemicals
- Exposure to fumes and smoke
- Allergens that come into contact with the eye
- Inward growth of eyelashes or condition known as trichiasis
- Pink eye or the condition called conjunctivitis that is caused by infection
- Injury to the eye that may be brought by direct or indirect blow
- Accidental poking of the eye
- Eyestrain
- Dry eyes condition
- Bright lights exposure
- Lack of sleep
- Exposure to cold winds
- Dust fumes
- Presence of pollen in the air
Diagnosis
Epiphora will manifest through overflowing of tears on the face and eyelashes. The eye becomes red due to irritation and a lump or tenderness in the inner corner of the eyelid may appear especially when due to infection of the lacrimal duct openings. Blurred vision is common as the vision is blocked by tears.
picture 5: Ducts and Gland position near the eye
image source: nashvillelidsurgery.com
image source: nashvillelidsurgery.com
Diagnosing watery eye condition can be easily detected by general practitioners or primary care physicians although when the condition cannot be determined or when there is suspicion of an underlying condition, an ophthalmologist or eye care specialist is necessary. Ophthalmologist will primarily ask for the symptoms and irritants that may have caused watery eyes.
A probe might be used to determine blockage through insertion in the narrow drainage channels of the eyes. Liquid drops will be facilitated to determine whether it comes out of the nose.
picture 6: flourescein dye is induced in the eye to find blockage in ducts and glands of the eye.
image source: remedicajournals.com
If the tear duct block is determined, a dye called flourescein dye is utilized to determine the location or the channel of obstruction occurrence.
Treatment
Treating epiphora depends on the cause and location of the obstruction. Environmental factors of epiphora may be treated with medications to prevent further irritations. Epiphora due to allergens are treated with antihistamines whether orally or through eye drops.Antibiotics are indicated for epiphora due to bacterial infection. These are non-surgical treatment indicated for epiphora due to environmental factors or any other irritants.
Surgical treatment is indicated for epiphora due to obstruction in the lacrimal drainage system. The procedure will create a new channel for the tears to drain.
This surgical procedure is known as dacryocystorhinostomy. Lid repair is indicated for epiphora caused by inward growth of eyelashes or caused by ectropion or outward protrusion of the eyelids.
