What is Epiphora? – Everything You Need To Know

We’ve all experienced watery eyes for one reason or another. It might have been triggered by a particularly emotional movie or perhaps something flew into your eye. In many cases, watery eyes are not unusual and can often be due to something easily identifiable, innocent, and fleeting. However, on occasion, you may find your eyes routinely overflowing with tears for no good reason, and it’s these occasions that may bring you to your eye care professional where you might hear the term “epiphora”. So, what is epiphora?

What is Epiphora?

Epiphora is the medical term for the overflow of tears from the eyes or watery eyes. It can occur due to an eye condition or disease, or it may be a reflexive reaction in an attempt to wash away some sort of irritation to the eyes, such as dust or chemical fumes. 

Causes of watery eyes can include:

• Conjunctivitis: watery eyes from allergic conjunctivitis is usually easily identified as they’re often accompanied by other allergy symptoms such as itching and redness of the eyes. You may also have the typical symptoms of hayfever, such as sneezing and a runny nose. Viral conjunctivitis also tends to present with watery eyes alongside redness and itching or burning; you may have also had a recent cold or flu. 
• A foreign object in the eye: the natural reflex of the eye when encountering a foreign particle is to produce tears in order to flush it away; there may be accompanying discomfort or irritation. 
• Trauma to the eye: this can be as mild as accidentally brushing a finger against your sensitive cornea or as severe as a laceration to the eye. Depending on the extent and type of trauma, you can expect other symptoms including pain, redness, and decreased vision.
• Infection or inflammation to the cornea: known as keratitis, this can be from a variety of causes including bacterial or viral. Keratitis is often accompanied by a sore eye, glare sensitivity and potentially decreased vision.
• Dry eye disease: although counterintuitive when considering the definition of what is epiphora, a dry eye’s surface triggers a reflex to produce more tears, which may then end up overflowing and resulting in a watery eye. Addressing the epiphora then becomes a matter of actually treating the eyes for dryness.
• Changes to the structure or function of the nasolacrimal system or eyelids: ageing, facial trauma, or unusual growths may impede the normal drainage of tears from the surface of the eye, leading to epiphora. There can often be no other outwardly noticeable abnormalities. Such cases may require the attention of an eye specialist and oculoplastic surgery. 

The Nasolacrimal System and Eyelids

The nasolacrimal system of the eye is responsible for the production of tears and its drainage from the surface of the eye. The lacrimal gland sits just above the top eyelid towards the outer corner of the eye and secretes its tears onto the surface of the eyeball. Tears play an important part in the health of the eye and are significantly more than just saline, providing lubrication, protection, and various nutrients and immune factors to the surface of the eye. Due to gravity, these tears eventually pool along the margin of the bottom eyelid. The blinking motion of the eyelids flushes these tears towards the inner corners of your eyes, which contain two small openings known as puncta on the top and bottom eyelids; from there the tear fluid then drains via a system of ducts through the nose and down the throat. 

Any dysfunction or alteration to the structure of the nasolacrimal system or the eyelids has the potential to induce a watery eye as it impedes the normal drainage of tears. This can occur in one eye and not the other, or be present in both eyes but more pronounced in one. Issues to these parts of the eye may only be able to be resolved with oculoplastic surgery, a subspecialty of ophthalmology that cares specifically for the eyelids and associated anatomy. 

An eye specialist in oculoplastic surgery is able to assess the function of your eyelids, including whether they are able to close in such a way that efficiently moves tears towards your puncta, whether they are sitting in an appropriate position against your eye’s surface, and whether there are any bumps or distortions along the lid that may disrupt the normal drainage of tears. Surgical procedures such as tightening of a loose lower eyelid such that it sits well-positioned against the eye, known as blepharoplasty, or excision of a disruptive bump along the eyelid margin may be the solution in these cases. 

Often a narrowed section of the nasolacrimal system is the underlying reason for epiphora and requires an experienced ophthalmologist in oculoplastic surgery to treat the obstructed area. Punctoplasty and an insertion of a stent may be necessary to widen a narrowed punctum, or in some cases, an entirely new channel from the eyes to the nose may be surgically constructed in a procedure known as a dacryocystorhinostomy.  

Rather than putting up with a persistent, bothersome watery eye with tears constantly flowing down your cheek, having an eye examination by an appropriately experienced eye care professional can identify what is your epiphora caused by and how it can be best treated.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.