Welled-up eyes, shedding a tear or two during an especially grilling viva or that botched up presentation in office, crying buckets (figuratively) after watching a tear-jerker (like The Notebook), or wailing on reading the death of your favourite character ('Sirius'ly), is all normal, and may even be healthy. However, excessive or persistent crying or tearing without apparent reason may be a sign that it's time to pay your physician a visit.
The tear film, present at the outer surface of the eye, functions to keep the eye lubricated, washes away debris and provides adequate oxygen. As the cornea (the outermost part of the eye) is devoid of blood supply, the tear film is responsible for providing oxygen to it. In normal conditions, tears are secreted by the lacrimal glands (located above each eyeball, towards the outer part of the eyelid), moving to the surface of the eye, before ultimately draining into the nasal cavity.
Any deviation, resulting in excessive secretion or inefficient drainage, may cause hyper-lacrimation and epiphora, respectively. Both conditions are commonly referred to as watering eyes - tears overflowing from the conjunctival sac (the part that covers the inside of the eyelid).
What causes watering eyes?
The reasons for excessive tearing or lacrimation can be aplenty. These could include:
1. Lacrimal gland tumours: In the early stages of their development, lacrimal gland tumors (often benign that do not lead to malignant cancers) and cysts directly stimulate the lacrimal gland to release tears.
2. Inflammation of the lacrimal gland: This can be due to infections like EBV (Epstein-Barr Virus) and Staphylococcus aureus, causing redness and soreness of eyes. Autoimmune diseases like Sjogren disease, where the immune system of the body begins to attack the glands that are responsible for moisture, like eyes or mouth, may also be responsible. Sometimes, it can just be idiopathic, meaning the primary reason is unknown.
3. Lumps: Lumps in or around the eyelids may irritate the ocular surface - itchiness, burning and cloudy vision are common. This results in tears falling reflexively.
4.Thyroid disorders: Graves' disease is an autoimmune disorder that causes hyperthyroidism. It is characterised by ophthalmopathy, where incomplete blinking interrupts corneal lubrication, resulting in tearing. Constant tears can also interrupt daily activities, more importantly pointing towards underlying disorders.
5. Inverted eyelashes: Medically called 'Trichiasis", in-turned eyelashes may irritate the cornea and conjunctiva, which presents as hyper-lacrimation.
6. Conjunctivitis: Often called 'Pink eye', this inflammation of the conjunctiva, that covers the white part of the eyeball, is characterised by discharge and crusting around the eyes along with common symptoms of inflammation like redness and soreness. Allergies or infections can obstruct the punctum (tear duct opening), leading to excessive watering. It is recommended to maintain distance from persons affected with pink eye/eyes, so as to avoid contracting it.
7. Psychical lacrimation: It is seen in states of intense emotions and also in hysteria. Watering may be due to voluntary lacrimation as well.
8. Acute glaucoma: This is a condition of the eye that causes sudden visual disturbances, accompanied by nausea and severe eye pain. This may also trigger hyper lacrimation.
9. Parkinson's disease: Brain disorders like Parkinson's disease or even progressive supranuclear palsy (causes disturbances in vision, balance, swallowing, etc.) can affect the 'blink neural circuit,' which leads to a depressed rate of blinking. Drying of the ocular region can cause pumping difficulties and reflex tearing.
A few tests that might help clinically evaluate 'watering eye' are examination of the eyes using magnification, lacrimal syringing test for determining where the obstruction is, and lacrimal scintillography for gauging the efficiency of the lacrimal drainage apparatus.
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