“Why Are You Crying?”

Watery eyes can cause a lot of embarrassment.  Well meaning people may ask if you are sad or upset.  Nothing is wrong… except you don’t know why your eye is misbehaving.  Constant wetness on the skin can make it crack and hurt because tears are very different from water.  Tears contain a lot of proteins, enzymes, oils, and antibodies to fight infection and moisturize the eye.  However, this important liquid is not appreciated by your skin and it can leave an annoying salty residue on your glasses and skin when it drips over the edge of your lid.

The first step in dealing with watery eyes is to never wipe your lids.  Stretching and rubbing them will loosen them over time and contribute to more watering.  It is best to blot gently with a tissue and avoid any pulling action on your lids.  The second step is to have a thorough eye and tear drain exam to determine the cause.  There can be a laundry list of contributing factors.

Ironically, dry eyes can be watery eyes.  This is because the sensitive cornea does not like dry spots and will send a signal to your tear glands to pump out more tears too quickly.  However, the quality of the tear film is critically important.  Many people have thick plugged oil glands that resemble butter along the edge of the eyelids.  This oil should really be transparent and flow freely in order to coat and prevent evaporation of tears.  Intermittent blurry vision while reading is a typical symptom of poor quality oils.  Using a moist warm compress for 15 minutes every evening over the lids may help melt the thickened oils and improve their flow.  In winter, dry eyes get a double whammy.  Outdoor cold air holds less moisture and many indoor environments have a dry forced air heat source.  Using over the counter artificial tears 3 to 4 times daily can help counteract this dryness.  It is best to use moisture tears preventively and routinely, instead of waiting for symptoms of dry, burning, itchy eyes in order to fully heal the dry spots.

There could also be a problem with the strength of the tear pumping action of the eyelids.  During our blink cycle, we generate some force on the tear channels that drain the tears off the eye surface.  But older folks generally have looser lids.  Sometimes a simple eyelid tightening will resolve the watery eye problem.  Other times the small tear drain holes at the inner corner of the eye have rotated away from the eye surface or have closed up.

Occasionally someone has a plugged tear drain due to previous infection, trauma, autoimmune illness, or chronic sinus congestion and allergies in the nose.  If medical therapy fails, it may be necessary for surgery to reestablish the outflow pathway.

A treatment of last resort for watery eyes is a tiny amount of neuromodulator such as Botox.  When given to the lacrimal gland, it can slow down the production of tears.  This is a very quick and completely painless office injection.  Yes, Botox is an incredibly versatile medication!

Vivian Schiedler, MD is an oculofacial plastic surgeon, specializing in the support structures of the eyes as well as facial rejuvenation.  For appointments, call (541) 708-6393.