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Causes of epiphora are any that cause either overproduction of tears or decreased drainage of tears, resulting in tearing onto the cheek. [2] This can be due to ocular irritation and inflammation (including trichiasis and entropion) or an obstructed tear outflow tract, which is divided according to its anatomical location (i.e., ectropion, punctal, canalicular or nasolacrimal duct obstruction).
Watery eyes – due to excessive tearing. [7] Red eyes – due to dilated blood vessels on the sclera. [7] Swollen eyelids – due to inflammation. [7] Crusting at the eyelid margins/base of the eyelashes/medial canthus, generally worse on waking – due to excessive bacterial buildup along the lid margins. [4] [5] [7]
A punctal plug, also known as tear duct plug or lacrimal plug, is a small medical device that is inserted into the tear duct (puncta) of an eye to block the duct. This prevents the drainage of liquid from the eye. They are used to treat dry eye. Artificial tears are usually still required after punctal plug insertion. [1]
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[12] [13] Besides leading to dry eyes, the obstructions can be degraded by bacterial lipases, resulting in the formation of free fatty acids, which irritate the eyes and sometimes cause punctate keratopathy. Meibomian gland dysfunction is more often seen in women and is regarded as the main cause of dry eye disease.
With the eye generally profusely watering, the type of tears being produced have little adhesive property. Water or saline eye drops tend therefore to be ineffective. Rather a 'better quality' of tear is required with higher 'wetting ability' (i.e. greater amount of glycoproteins) and so artificial tears (e.g. viscotears) are applied frequently.
One may experience excessive tearing such as if something got into the eye. These reflex tears will not necessarily make the eyes feel better since they are the watery tears that are produced in response to injury, irritation, or emotion which lack the lubricating qualities necessary to prevent dry eye. [4]
Artificial tears are the recognized treatment of choice for this problem. [15] Artificial tears work by adding similar lubricating elements that natural tears contain. [17] This helps thicken and stabilize the pre-corneal tear film, prolonging tear film breakup time, and allowing for tears to properly protect the surface of the eyes. [17]