Epiphora (or excessive tearing) happens when tears overflow from the lower eyelid onto the face. The condition can be caused by a number of factors, ranging from allergic reactions to inflammation, infections or injuries. Regardless of the underlying cause, excessive tearing can be uncomfortable and inconvenient. Here are the most common causes and risk factors for epiphora as well as available treatment options.
Epiphora can be caused by a variety of factors, some of which include:
1. Meibomian Gland Dysfunction (MGD): The leading cause of dry eye disease is MGD (or evaporative dry eye). When the tear film evaporates too quickly, the lacrimal gland often becomes overactive which may lead to an overproduction of tears.
2. Allergies: Allergies cause inflammation, which can result in excess tear production.
3. Blocked tear ducts: This condition occurs when the nasal lacrimal ducts (NLD) responsible for draining tears become obstructed, leading to overflow of tears.
4. Infections and Inflammation: Infections on the surface of the eye, like conjunctivitis, or conditions like Ocular Rosacea or Blepharitis cause inflammation that can lead to excess tear production.
5. Eyestrain: Prolonged or incorrect use of the eyes like frequent reading or focusing on a screen for a long period of time can result in excessive tearing.
6. Eye injuries: External injuries or trauma to the eye or face can result in tearing.
7. Ocular Surface mechanics: As the eyelids close, they act as windshield wipers pushing the tears toward the drainage ducts. In patients with significant Conjunctivochalasis (CCH), a condition where the conjunctiva is loose or redundant, the mechanical blink may fail to function properly leading to tears falling off the cheek.
Some individuals are more prone to developing epiphora than others. Examples of people who may be at an increased risk include:
1. Age: As people age, their tear ducts tend to narrow naturally, making them more prone to epiphora.
2. Eye surgeries: After undergoing eye surgery, some individuals may temporarily suffer from epiphora due to the natural swelling that occurs post-surgery.
3. Radiation therapy: Individuals who receive radiation near the head or neck may experience conditional epiphora.
4. Previous infections: Individuals who have had certain types of bacterial or viral infections like chlamydia or herpes are more likely to develop epiphora.
The treatment for epiphora will depend on the underlying cause. The following are some available treatment options:
1. Eye Drops: If the excessive tearing is caused by dry eye, allergies, infections, or inflammation, the use of certain types of eye drops could prove beneficial.
a. For patients with MGD, preservative-free eye drops such as Optase MGD, Retaine MGD, Oasis Tears, and iVizia may be helpful.
b. For patients with ocular allergies, consider either Alaway PF or Pataday eye drops.
c. For patients with inflammation or infections, consider topical prescription Eysuvis steroid drops, Tobramycin antibiotic eye drop, or combination antibiotic/steroid therapy (ie Tobradex or Maxitrol).
2. Office-Based Treatments such as Light Therapy, Thermal Expression, Lid Exfoliation, Meibomian Gland Probing (MGP), Dilation/Irrigation.
a. Light Therapy with IPL or Low Level Light Therapy (LLLT) for MGD/Rosacea.
b. Thermal Expression with Lipiflow, TearCare, iLux, RadioFrequency for MGD.
c. Lid Exfoliation with BlephEx or ZEST for Blepharitis.
d. MGP for fibrotic/scar tissue within the oil glands for advanced MGD.
e. Dilation & Irrigation for removing obstruction inside the drainage ducts.
4. Warm compress: In cases where epiphora stems from a blockage in the oil glands or drainage ducts, a warm compress applied to the affected area could help relieve it and promote oil production as well as proper drainage.
5. Other medications: Oral doxycycline for its antibiotic and/or anti-inflammatory properties, Flonase/Rhinocort (fluticasone or budesonide) nasal spray for allergy relief, Muro 128 hypertonic ophthalmic saline ointment or drops for decreasing swelling or edema.
6. Surgery Intervention: People with narrow or obstructed tear drainage ducts could benefit from surgical correction that aims to widen the NLD ducts or clear any obstructions.
To wrap up, Epiphora is a medical condition that may require medical intervention to fully resolve. Effective treatment involves correctly identifying the underlying causes and taking measures to manage them. If you are experiencing excessive tearing (or epiphora), contact our office to quickly receive an accurate diagnosis as well as tailored treatment for your situation.