Excessive Tearing
In order for the eye to remain healthy, it must remain moist. Each time you blink, the eyelid spreads the tears over the surface of the eye and pumps excess tears into a “duct” that drains the tears into your nose. That is why your nose runs when you cry. Excessive tearing not only could be annoying, it also could be interfering with vision if severe.  Tearing problem can be due to either excess production of the tears or deficiency of tear drainage.

Any irritation to the surface of the eye can lead to reflex tearing.  Most commonly, blepharitis (inflammation of eyelid margin), dry eye syndrome, allergy of the conjunctiva (skin covering white part of the eye) and corneal abrasion (scratches) are all possible causes of excessive, reflex tearing.  The treatment should target the source of the problem, usually involving optimizing the health of the ocular surface and providing sufficient lubrication to the eye.

Tears drain from the inner corner of the eye via two opening (puncta), one in the upper eyelid and one in the lower eyelid.  The openings guide the tears to“drainage ducts” or canaliculi, which fuse and form a larger sac (nasolacrimal sac).  The drainage system then empties into the nasal cavity via nasolacrimal duct.  Any obstruction along this pathway can produce symptoms of excessive tearing.

Punctal and canalicular obstruction
Chronic inflammation/infection and subsequent scarring of the duct opening (punctal stenosis) and the duct itself (canalicular stenosis) are not uncommon among the patients with complaint of excessive tearing.  The openings or puncta can also be covered by loose conjunctiva (skin covering the white part of the eye), a condition which is age-related and associated with chronic allergy of the eye.  These conditions are treated with various medical and surgical interventions.

Nasolacrimal Duct Obstruction
Even more downstream along the drainage pathway, nasolacrimal duct can be blocked, with backed-up tears spilling over the eyelid and running down the face.  The stagnant tears within the system also may cause infection of the nasolacrimal sac or dacryocystitis.  It presents with a painful swelling in the inner corner of the eyelids and requires systemic antibiotics.  If the tearing causes severe symptoms or chronic infection, surgery can be performed to create a new tear duct.  This operation is called “dacryocystorhinostomy or DCR.” Your doctor will place small silicone tubes temporarily to keep the new tear duct open while healing occurs. Surgical elimination of the obstruction by creating a new tear duct is necessary to eliminate the tearing and infection that can result from such a blockage.