Tearing/Epiphora

Greetings to all and sundry,

It is another beautiful day today and a wonderful opportunity to come your way with another one of our health discussions. Before we move on, however, I do hope you my dear reader are doing amazing and having a wonderful time.

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For our topic of discussion today we would be looking at a very common symptom that cut across a lot of conditions and what it could signify. Let's look at the lacrimal system and how tearing relates to the various conditions.


Introduction


The Lacrimal system or Tear system is one of the important systems of our eye that cannot be underestimated in function. It contributes to the protection of the ocular integrity and vision as a whole and without it, a lot of things about the eye could be highly uncomfortable.

The lacrimal system consists of the lacrimal gland located slightly above our eyes around the area of the eyebrow which produces most of the tears or aqueous that flow on our eyes. There's also the drainage system that passes through the punctum around the nasal part of the lower lid, through the canaliculi into the nasolacrimal duct which empties into the nose and down the throat.

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Tear has 3 components which include the aqueous, mucus, and lipid all of which must come together to ensure that it functions accurately. It also has lysozymes and antimicrobial properties to keep it safe and foreign bodies and objects from getting to it.

Naturally, we produce what we call basal tears which is the normal amount of tears that flow over the eyes all the time or at every point in time. When the production occurs in excess then we have what we call tears. It is the same thing that happens when we cry.


Tearing


Overproduction of tears may occur when we are triggered emotionally as impulses go to the lacrimal gland, this may come in the form of pain, joy, etc. In many ocular conditions tearing is observed and thus may not necessarily be used for diagnosing of a condition however it may help direct your path in eliminating differential diagnosis.

A lot of times when we experience pain in or in the eye we tend to tear a lot in response to the impulses being sent, in dry eye conditions tearing may come about as the eye tries to compensate for the inadequacy of the tear film or the tear film integrity been compromised by one of the three components of the tear film.

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Tearing may also occur when foreign bodies or objects get on to the eye, this is a natural reflex by the ocular system in trying to get whatever may have gotten into the eye out and this tends to work a lot of times. In situations like pterygium or pinguecula, it may present as a foreign body on the eye which could also elicit a similar response.

Tearing may signify that something is wrong somewhere and it could also be a natural physiological process that shouldn't cause worry, fear, or panic. For instance, I have had patients come in to complain that they tend to tear when they feel exhausted or when they are sleepy, when they wake up early in the morning and when they yawn. All of these are very natural and very much expected and should happen, thus you shouldn't worry about these when they happen.


Conclusion


In many cases, issues of tearing and tear film integrity being compromised is been treated or managed with artificial tears after assessment with the slit-lamp by your Optometrist mostly under the cobalt blue light and under fluorescein staining.

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Tearing could be discomforting sometimes when it becomes uncontrollable and so in any case should you suspect something is wrong it would be of utmost importance to seek immediate medical care as some of the conditions may be quite serious. In all cases, early detection saves
sight. Take care of yourself always and love your eyes.


Further Reading

Swampillai, A. J., & McMullan, T. F. (2012). Epiphora. British journal of hospital medicine (London, England : 2005), 73(11), C162–C165. https://doi.org/10.12968/hmed.2012.73.sup11.c162

Lee, J. M., & Baek, J. S. (2021). Etiology of Epiphora. Korean journal of ophthalmology : KJO, 35(5), 349–354. https://doi.org/10.3341/kjo.2021.0069

Broder, C. F., & Chazan, J. F. (2020). Epiphora due to a supernumerary lacrimal punctum treated with lacrimal plugs. Case presentation and literature review. Epífora secundaria a punto lagrimal supernumerario tratada con tapones de vías lagrimales. Presentación de un caso y revisión de la literatura. Cirugia y cirujanos, 88(Suppl 1), 28–30. https://doi.org/10.24875/CIRU.19001305.

Avdagic, E., & Phelps, P. O. (2020). Nasolacrimal duct obstruction as an important cause of epiphora. Disease-a-month : DM, 66(10), 101043. https://doi.org/10.1016/j.disamonth.2020.101043.



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