Excessive lacrimation

Excessive lacrimation of the eyes means that too much tears flow from the eye.
Tears serve to keep the surface of the eye moisturized, and they also flush particles and foreign bodies out of the eye.
Tearing from the eyes occurs at any age, but it is most common in young children and older people over 60 years of age.

It can be observed in one or both eyes.


Where do the tears of the eyes come from?

The lacrimal apparatus consists of a secretion system and the outflow or absorption of the tears.
Excessive lacrimation may be caused by excessive production or decreased absorption of tears.

  • The eye fluid consists mainly of fine mucus and watery secretions of the main lacrimal glands in the upper outer orbital area of the eye.
  • The drainage takes place via two tear dots, which are small openings that are located on the trailing edge of the eyelid margin.
  • From here, the tears enter the tear ducts, which empty into the lacrimal sac, a vertical storage located in the tear pit.
  • From here, the tears drain into the nasal tear duct and into the nasal passages.

The liquid produced is used to clean the eyes when the eyelids slide over them.

What are the causes of excessive lacrimation?

  • Emotions can lead to crying.
  • Anything that irritates the eye can lead to excessive lacrimation. This is a protective reflex to derive irritating substances such as: onion, smoke, chili.
  • A grain of dust or sand that has caught the eye.
  • Climate – Cold and wind can lead to excessive lacrimation.
  • Ectropion – the eyelid is turned outwards and prevents eye closure.
  • Changes in the tear film, for example, lipids (fats) can change the tear fluid.
  • As a result, the tear film may no longer be able to spread evenly over the front part of the eye.
  • Dry eye syndrome: a disorder altered by the quality and quantity of tears. If the tears no longer adhere properly to the eyeball, the lacrimal gland is stimulated to produce a larger amount of tear fluid.
  • Corneal abrasion is an injury to the corneal surface (transparent dome-shaped structure in the front part of the eye).

Inflammation and infection of the eye

  • Conjunctivitis is an inflammation of the transparent layer that covers the sclera (the whites of the eyes) and eyelids, causing reddened eyes and pain.
  • The secretion caused by viral conjunctivitis is clear and watery, but may also contain light yellow or white mucus.
  • The tears in bacterial conjunctivitis are denser and resemble pus, they are usually of yellow, green or gray color.
  • The ocular secretions caused by allergic conjunctivitis are watery.
  • Blepharitis is a chronic disease of the eyelids characterized by inflammation in the area where the eyelashes grow.
  • The result is an unusual production of sebum from the meibomian glands on the inner edge of the eyelid.
  • Symptoms of inflammation of the meibomian glands include foamy tears, crusting on the eyelids, yellow or green pus leakage, eye pain and irritation.
  • Blepharitis can lead to heavy lacrimation in the morning.
  • Uveitis – is an inflammation of the uvea, i.e. the tunica vasculosa bulbi, which is formed by the iris skin, ciliary body and choroid.
  • Keratitis – inflammation of the cornea.

Occlusion of the tear ducts

  • defective outflow of tears. The tears can be blocked instead of absorbed.
  • Narrowing of the tear ducts – the most common cause of severe lacrimation in the elderly is a blockage in the tear duct.
  • The cause is probably a mildly persistent inflammation.
  • With the narrowing of the tear duct, there is not only watering of the eyes, but the tears can also accumulate and infect in the canal.
  • If the lacrimal sac is infected, this leads to sticky tears in the eye.
  • Manchmal ist der Tränenkanal nicht vollständig blockiert, ist jedoch zu eng, als dass alle Tränen ablaufen könnten.
  • Some children are born with a tear duct that is not yet fully opened. This problem often exists and resolves itself within a few weeks without therapy, because the channels open completely.

Rare causes
Rarely, there may be a blockage inside the tubules or at the canal entrance in the inner corner of the eye. This can be caused by inflammation or fibrosis.
Rarely, a nasal polyp can prevent the tears from exiting the tear duct.
Thyroid disorders are rare causes of excessive lacrimation.

Types of tears (or secretions) of the eyes

Dense grey-green tear fluid
Yellow-green secretions from the eyes may indicate a bacterial infection of the eyes. Bacterial conjunctivitis can lead to occlusion of the eyelids in the morning.

Mucous yellow secretion
Yellowish tears on a small nodule on the eyelid may be
caused by a stye.
The glands of the eyelids can be infected and secrete mucus.

Watery and purulent tears
Dacryocystitis is an infection of the nasal outflow system, which leads to the formation of a white-yellow mucous ball.
Those who suffer from dacryocystitis feel facial pain, redness and swelling around the eyelids near the nose.
One may also notice secretions emerging from a small opening on the eyelid.
This condition can be severe.

White tears
White tears may be caused by allergic conjunctivitis.
Allergies to the eye can be very uncomfortable.

Watery tears with mucus
Excessive watery lacrimation mixed with a small amount of mucus may be caused by a virus.
Viral conjunctivitis causes various symptoms, including eyelid swelling, fogged vision, red eyes, and a foreign body sensation.

Symptoms of watery eyes

The main symptom of watery eyes is the production of tears without any cause.
Your eyes may water more when you’re outdoors, especially when it’s windy or cold.

Other symptoms include:

  1. Mucus, crusting or a sticky feeling in the eyes.
  2. Pain and swelling at the inner corner of the eye near the nose.
  3. Reddened and painful eyelid edges.

Diagnosis of excessive lacrimation

A narrowed tear duct is diagnosed through a number of examinations, including:

  1. Physical examination – including medical history.
  2. Augenuntersuchung mit der Spaltlampe – um andere mögliche Ursachen festzustellen.
  3. Ein Test, um den Abfluss von Tränen zu überprüfen – zum Beispiel wird eine spezielle Flüssigkeit in die Öffnung des betroffenen Tränenkanals (Tränenpünktchen) gespritzt. Spürt der Patient die Flüssigkeit im Hals hinunterrinnen, bedeutet das, dass die Kanäle frei sind.

Treatment of excessive lacrimation

The type of treatment depends on the cause of lacrimation.
If the symptoms are mild, no therapy is required.
Children born with occluded tear ducts do not require treatment.

► Antihistamines can help with allergies.
The Schirmer test is often used to determine the quality and quantity of tears.
As for the treatment of dry eyes due to insufficient tear fluid, the use of lubricants or special contact lenses could help.
If you have dry eyes, you should protect your eyes from weather conditions with low humidity.
Sun and wind exposure can increase symptoms.

► Infections such as conjunctivitis and blepharitis can be treated with antibiotics. Hot compresses can help and bring relief.

► If the drainage system is blocked, the surgeon can remove the blockage at the level of the lacrimal dots, the lacrimal ducts or the bags under the eyes.

Clogged ducts in newborns

Most cases of a blocked tear duct resolve in the first months of the newborn’s life, but at the first signs of occlusion of the tear duct, the ophthalmologist should be consulted to rule out a more serious problem.

First of all, the doctor may recommend a massage to favor the release of the lacrimal tubules.
For the massage, parents must place a finger between the eye and nose of the newborn, feeling the nasal bone or a small nodule.
Here you have to make a horizontal movement from the nose to the eye with light pressure, along the course of the tear ducts.
With an infection, pus and a secretion can be seen leaking.

► In the case of a partial blockage of the tear ducts, the ophthalmologist can use a probe to widen the duct (probing the lacrimal ducts).
Often the insertion of a tube is sufficient to free the tear ducts of the child.

► Sometimes the surgeon inserts a small tube to widen the tear duct. This tube remains for six months and is then removed again.
The procedure is performed under local anesthesia, takes about 30 minutes and usually solves the problem permanently.

► Surgery may be performed to correct a malformation of the eyelids such as ectropion (rolled outwards) or entropion (rolled inwards).

Natural remedies for excessive lacrimation

The area around the eyes and eyelids must be clean and without crust.
If a hot poultice is placed on the eyelids for a few minutes, this can alleviate the symptoms.
For the envelope, dip a towel in hot (not boiling) water. A cold envelope helps reduce eyelid swelling.
If the tear flow occurs through contact with irritating substances present in the environment such as smoke, dust or chemicals, this can be easily treated with artificial tears.
Before going out, you should put on sunglasses, especially if it is very sunny or windy.

Surgery for excessive lacrimation

If the tear ducts are blocked and no other therapies help, the ophthalmologist can perform an intervention to expand the lacrimal sac that ends in the nose.
The operation is called a dacryocystorhinostomy or DCR.
This procedure can be performed under local or general anesthesia.
A special X-ray of the tear duct may be required to determine exactly
where the blockage is located.

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