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MattiSeppänen

Watering Eye

Essentials

  • Common causes of watering eye are irritation of the eye's surface caused by dry eye, stenosis of the nasolacrimal duct and abnormal position of the eyelid.
  • Other possible causes include eyelid inflammation, conjunctivitis and keratitis.
  • As initial therapy it is usually sufficient to soothe the eye's surface with artificial tears and to treat infections in the eye area.
  • Malpositions of the eyelid should be corrected, as required, by a surgical intervention.
  • A general practitioner may perform an irrigation of the lacrimal drainage system in an adult patient.

Causes of watering eye

  • See Table T1.

Most common causes of watering eye

CauseSymptomsFindings
Lacrimal duct stenosis Lacrimal Duct Stenosis
  • Recurring conjunctivitis
  • Abundant tearing and purulent discharge
  • Tearing and purulent discharge from the eye
  • In lower lacrimal duct stenosis, pressing on the lacrimal sac produces pus or mucus from the lacrimal punctum
Eyelid turned inward (entropium) Entropion and Ectropion
  • Pain
  • Redness
  • Foreign body sensation
  • Watering
  • Recurring conjunctivitis
  • Eyelashes touching the eye
  • Punctate keratitis or ulceration of the cornea (best seen by fluorescein staining under blue light)
  • Conjunctival erythema
  • As the patient squeezes their eye shut and opens it, the eyelid may remain in a malposition turned inward.
Eyelid margin turning outward (ectropium) Entropion and Ectropion
  • Watering
  • Dry eye symptoms
  • Eyelid turning outward
  • Conjunctival erythema
  • Punctate keratitis or ulceration of the cornea
Dry eye syndrome Dry Eye Syndrome
  • A dry, foreign body or gritty sensation
  • Itching
  • Watering
  • Eye fatigue
  • Variation of visual acuity
  • Erythema and chemosis of the conjunctiva or of eyelid margins
  • Decreased fluorescence tear break-up time (FBUT)
  • Fluorescein staining of the cornea and conjunctiva
Blepharitis Blepharitis
  • Itching
  • Foreign body sensation
  • Purulent discharge
  • Watering
  • Rounded and erythematous eyelid margins
  • Crusty eyelash roots
  • Erythema and scaling of the skin
  • Obstructed Meibomian glands
  • Scarring and malposition of the eyelid
Conjunctivitis ConjunctivitisBacterial inflammation
  • Erythema, itching and gritty sensation in the eye
  • Watering
  • Gluing together of the eyelashes, particularly in the morning
Viral inflammation
  • Itching, gritty sensation
  • Watering
  • Often concomitant upper respiratory tract infection
Bacterial inflammation
  • Conjunctival injection
  • Purulent, yellowish discharge
  • Subconjunctival accumulation of fluid (chemosis)
  • Erythema and oedema of eyelids
Viral inflammation
  • Conjunctival injection
  • Watery discharge
  • Erythema and oedema of eyelids
Keratitis Keratitis
  • Watering
  • Pain
  • Photophobia
  • Impaired vision
  • Redness of the eyes
  • In allergic form, eyelid skin affected
  • In fluorescein staining, changes seen under blue light
Conjunctival or corneal foreign body A Foreign Body on the Cornea
  • Watering
  • Redness
  • Pain
  • History of injury
  • Conjunctival foreign bodies may be difficult to find.
  • Linear scratches on the cornea seen in fluorescein staining may reveal a foreign body underneath the upper eyelid.

    References

    • Seppänen M, Kaarniranta K, Setälä N, Uusitalo H (eds.). [Handbook of ophthalmology]. 3rd revised edition. Helsinki: Duodecim Publishing Company Ltd, 2022.