OCULAR SYMPTOMS 

Tearing and Discharge

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Introduction: Tearing and discharge

Tearing can be caused by two basic mechanisms: overproduction of tears, and a blockage of tear drainage away from the eye. Sometimes a combination of the two can coexist. The tears are produced by numerous glands present on the insides of the eyelids. Tears drain away from the eye through two small openings (lachrymal puncta) present at the edge of the eyelid near the inside corner (upper and lower lids). When the eyelids blink, tears are milked into these openings, and drain through narrow tubes to a sac under the skin at the inside corner of the eye (lachrymal sac). Tears then drain into the nasal cavity. Two conditions leading to obstruction of this tear drainage system are discussed here. Other conditions capable of causing tearing and discharge that are discussed on other pages of this Symptom and Diagnosis section are listed below with possible distinguishing features.

Conditions:

For eye anatomy explanations, go to ANATOMY

Obstructed tear drainage system

Blockage of the tear drainage system is a common cause of painless and spontaneous tearing. 

 

The affected eye or eyes have to be frequently wiped throughout the day as the tears drain onto the skin. Often the skin itself becomes irritated and red from the wiping. Sometimes the tears can drain out at very inappropriate times during social encounters.

Why obstruction of the tear drainage system occurs is not well understood. There can be an association with sinus problems, and low grade infection of the system can lead to scarring and blockage. Some people have a problem with the eyelid not being flush against the eye (ectropion of the eyelid), and tears thus have no way to enter the lachrymal puncta to drain away. Certain medications can lead to scarring to the tear drainage symptoms. Rarely, tumor can obstruct the system.

Treatment is aimed at establishing a diagnosis and a probable cause for the obstruction. Fluid irrigation of the system using a smooth tube can help to determine exactly where the system is blocked. Sometimes the nasal cavity needs to be examined to see if any blockage is present there. In some cases the use of steroid-antibiotic eyedrops with oral decongestants may help to open the system and relieve the tearing. Warm compresses applied to the inside corner of the eye may help as well. In cases where nothing seems to work, surgery can create a new opening for tears to drain into the nasal cavity.

Dacryocystitis

Dacryocystitis (dak-reo-sis-stitis) is an infection of the lachrymal sac, or the sac into which tears drain from the eyes. Usually this appears as a painful, tender swelling present at the inside corner of the eye under the skin. There may be redness which can even extend onto the cheek. Tearing and discharge occur since tears have no way to drain beyond the infected sac. Treatment is by oral and eyedrop antibiotics. After a severe or recurrent infection, surgery may need to be done to create a new opening for tears to drain into the nasal cavity, preventing further infections.

Other Conditions causing tearing and discharge found on other pages: