Tears are necessary to lubricate the surface of the eye and to keep the window on the front of the eye (cornea) transparent. They also serve to kill bacteria and other microbes on the surface of the eye. Tears are produced by the lacrimal gland which sits on the upper outer corner of the eye. They move naturally across the surface of the eye, and are drained by two tiny collecting ducts called puncti which sit in the corner of the eye. From here tears are drained down through to the nose.
There are many causes of watery eyes, but broadly one can develop watering due to over production, or under drainage of the tears from the eye surface. Sometimes the lacrimal gland will produce too many tears in certain circumstances (e.g. windy/dry conditions) which leads to watering, or sometimes there is an abnormality of the eyelids themselves, or commonly there is an impairment to drainage anywhere from the collecting ducts down to where the tears drain into the nose.
Watering eyes can range from being an intermittent problem which only interferes occasionally in someone’s life, to being extremely troublesome and causing great distress. Some people may find that watering is only present when walking outside in windy conditions, whilst others may find that their eyes water all day long, whether inside or out. Depending on the degree of symptoms, and the cause of the watering, the treatment will vary.
The treatment of watery eyes very much depends upon the cause, but can range from medical (more conservative) treatments to minor surgical treatments, to more major operations.
If the cause of the watery eye is due to a poor tear film (dry eye) or due to blepharitis, then it may be the case that simple measures such as lid hygiene advice, or lubricating drops may improve the symptoms. These treatments work because they reduce irritation around the eyelids, improve the tear film quality, prevent evaporation of tears, and so prevent what some people term “reflex epiphora” which is watering secondary to a dry eye, or poor ocular surface.
If the cause of the watery eye is secondary to eyelid position, then sometimes small procedures to improve the eyelid position, or tighten the lower eyelid may improve the watering. These can often be done under local anaesthetic. These can sometimes improve the position of the inferior punctum ( lower tear collecting duct).
Sometimes if the lower collecting ducts of your eyelids (puncti) are too small, then a very small procedure can be done to widen these to allow easier drainage of tears from the eye surface and hence reduce watering.
If it is the case that the cause of your watering eyes is secondary to a blockage further down the tear collecting ducts, then an operation called a DCR (dacryocystorhinostomy) may be appropriate, which creates a “short cut” for the tears to drain into the nose, rather than going down the nasolacrimal duct (NLD). The success rate of this operation can range upward of 80-85% depending upon the site of the blockage and any pre-existing conditions.