What is lacrimation?

In some people, tears pool in the eye, either because of excessive production or because of poor drainage. Excess tears make the eye seem moist and allow tears to concentrate along the lower eyelid and subsequently drop to the cheek. This condition is called lacrimation.

How are tears produced and stored?

Small glands, found in the surface tissue of both the white of the eye (the sclera) and the one that covers the eyelids from the inside, continuously produce small quantities of tears, in order for the eyeball to remain healthy and, at the same time, lubricated, facilitating its movement. A bigger gland, called lacrimal, which is found under the upper eyelid, responds to emotional situations or eye irritation producing larger quantities of tears.

After tears are dispersed on the surface of the eyeball, they go inside a small opening that exists in every eyelid (lacrimal punctum) and are drained through a small tube (lacrimal canaliculi) to the lacrimal sac and from there there, through the nasolacrimal duct, to the nose. This explains the “runny” nose when we cry, since excess tears reach the nose through the natural drainage system of the eye.

What are the causes that can lead to lacrimation?

Overflow of tears can be caused when injuries, congenital malformations and infections, especially of the lacrimal sac, prevent drainage of the tears to the lacrimal punctum, the canaliculi, the sac or the nasolacrimal duct.
Furthermore, eye inflammations, eyelid disorders, eyelashes turned towards the cornea, exposure to strong winds, glaucoma, certain medicines, even tired eyes can bring excessive tear excretion.
However, excessive tear excretion is not always much larger than normal or does not always indicate an obstruction of the drainage system. People with dry eyes (xerophthalmia) often complain about lacrimation. This happens because the quantity of the tears that is excreted is too small to adequately moisten the eye, so it is usual for the lacrimal gland to react with producing additional tears that cause episodes of overflow, even though the basic problem is production of few tears or even dry eyes.

Excessive production of tears may be caused by:

Emotional situations
Dry eyes
Natural irritations (wind, smoke, vapors)
Infections and allergic reactions
Foreign objects on the surface of the eye
Glaucoma

Poor drainage of tears may be caused by:

Anomalies in the position of the eyelid or the lacrimal punctum
Faulty blinking
Infections
Orbital injuries (fracture, segmentation)
Congenital anomalies
Burn or radiotherapy complications

How can the cause of excessive lacrimation be defined?

In order to find which one of these factors causes excess tear excretion, the patient will have to undergo a full ophthalmological examination. The ophthalmologist may try to poor fluid through the drainage system towards the nose or perform other tests like measuring tear production or collecting tears from the nose.

How is excessive lacrimation treated?

Treatment always depends on verifying the cause of lacrimation (causal treatment). So, if it is caused by an eyelash turned to the cornea, it will need to be removed. If the problem is dry eyes, then a restorative therapy is in order with artificial tears or even obstruction of the lacrimal punctum with special plugs that will prevent the natural and artificial tears from draining out of the eyes (with either temporary collagen plugs that will be absorbed or permanent silicone plugs).

If the drainage system is obstructed, then the doctor will try to open or bypass it. So, when there is a small constriction of the drainage system, modern atraumatic microsurgery techniques that open the canal with the use of proper equipment and special lacrimal tubes offer essential help and prevent a total obstruction of the system. In cases of total obstruction, the sedition of tears within a closed system may allow for the development of microbes and lead to inflammation (dacryocystitis). Those infections can not only affect the patients' quality of life, but also demand careful monitoring and proper treatment in order not to endanger vision or the patients' general health. Patients with cataract and obstructed tear ducts need special attention because if cataract surgery is done, even with the most advanced techniques, before treating the obstructed duct, it may cause a serious infection inside the eye that will result in severe damage of vision.

Patients with chronic systemic disorders that affect the organism's defenses, like diabetes, or immunosuppressed individuals must be treated early because they are in even bigger danger for a possible spreading of the infection to nearby tissues.

Remember: Your ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.