Medical Edge Newspaper Column

Eyes That Water Easily May Actually Be Caused by Eye Dryness

October 2, 2009
Dear Mayo Clinic:
My mom, age 75, is bothered by extremely watery eyes. The symptoms are worse in stores with clothing or fragrances, in windy conditions, and air conditioning. What could be causing this? Over-the-counter allergy medications have not helped. What treatments might be helpful?

Answer:
It seems counterintuitive, but this situation sounds like the result of dry eyes. Tear production often decreases with age. Troublesome dry eyes are especially common in women past menopause.

Here's how dry eyes cause watery eyes: When normal tear production decreases, eyes become dry and irritated. Environmental factors such as wind, sun, air conditioning and fragrances can aggravate dry eyes even more. To counteract that dryness and irritation, the eyelids produce reflex tears — the tears that flow when you have something in your eye or when you cry. The amount of the reflex tears can overwhelm the drainage system. The result is watery eyes and excessive tearing.

The first-line treatment for this condition might seem counterintuitive, too. Apply over-the-counter artificial tear drops. By improving the underlying condition of dry eyes, reflex tear production is reduced. Drops without preservatives can be used frequently, even several times an hour. Your doctor can suggest how often to use drops with preservatives. You should avoid drops that include a redness remover. They can make dry eyes worse.

There's a host of other factors that can contribute to dry eyes. LASIK surgery, and some underlying medical conditions such as diabetes, rheumatoid arthritis, scleroderma, Sjögren's syndrome and vitamin A deficiency can cause dry eyes.

Commonly used oral medications can cause dry eyes, too. The list includes certain antidepressants; diuretics (for blood pressure control); birth control pills; antihistamines and decongestants; sleeping pills; opioid pain relievers (such as morphine); and isotretinoin-type drugs used for the treatment of acne.

Blepharitis, an inflammation along the edge of the eyelids, can cause dry, scratchy or watery eyes. Blepharitis occurs when tiny oil glands near the base of the eyelashes malfunction, leading to bacteria growth. With blepharitis, regular cleaning of the eyelids can improve symptoms. Diluted baby shampoo applied with cotton-tipped applicators usually works well. Your doctor could prescribe a short course of antibiotic eye drops or oral antibiotics to help clear up blepharitis.

Additional treatment for dry eyes depends on the underlying cause. Medications can be changed to see if dry eyes improve. If an underlying medical condition is diagnosed, treating that condition could alleviate dry eyes.

An eye doctor also could suggest ways to help preserve tears. The doctor can insert tiny silicone plugs into tear ducts to partially block drainage and thus preserve tears. Customized contact lenses can be used to hold tears on the eyes, too.

Dry eyes aren't the only possible cause for watery eyes. Other possibilities include:

• Blocked tear ducts: Normally, tears drain from small holes along the inner eyelids and into the nose. With aging, blockages in the ducts become increasingly common; tears pool and flow onto the face. When the ducts are partially blocked, an ophthalmologist can dilate the tear ducts, providing temporary relief. Surgery to open the blocked ducts is an option for more severe blockages. Most often, surgery is successful in improving symptoms.
• Other changes related to aging: With age, the muscles and tendons in the eyelids become more lax. The margins of the eyelids begin to droop or pouch outwards instead of adhering to the eye. This change interferes with normal tear drainage. Instead of draining, tears fill the outwardly pouched lower eyelid (ectropion) and overflow onto the checks. This can be treated surgically.
• Allergies: Allergies can also trigger excessive eye watering and can be treated with allergy medications.
• Underlying medical conditions: Watery eyes can be a symptom of thyroid disease. Graves' disease is a common thyroid disease and can present with watery eyes and several other eye symptoms, including a gritty feeling in your eyes, eyeballs bulging outward, swelling of the lids and tissues and light sensitivity. Your doctor can order a blood test to check thyroid hormone levels. There are a variety of treatments for eye symptoms of Graves' disease, ranging from medications to surgery.

Given there are so many possible reasons for your watery eyes, I'd suggest a visit with an ophthalmologist to determine the cause and to develop a treatment plan. Chances are very good that treatment is available to improve your symptoms.

— Sophie Bakri, M.D., Ophthalmology, Mayo Clinic, Rochester, Minn.