Increased lacrimation of the eye – epiphora (lat. Epiphora)
Causes and origin of the disease:
Patients with problems due to excessive watering of the eye very often come to the ophthalmology clinic. This condition is called epiphora (lat. Epiphora). As we know, tears are produced in the lacrimal gland
(lat. Glandula lacrimalis) which is located under the upper eyelid a little above and on the outside of the eyeball and to a lesser extent in other, auxiliary lacrimal glands. Tears are distributed over the entire surface of the eye by blinking and go in the direction of the nose, where they are drawn into the tear ducts and the lacrimal sac through which they go into the nose. So, it can be said that increased lacrimation of the eye occurs if too many tears are produced that cannot flow out quickly enough through the canals or with a normal amount of tears if the canals are blocked. Increased tear production is influenced by emotions (crying), eye stimuli (smoke, smog, nicotine irritant gases), foreign bodies (dust), inflammation, conjunctival and corneal injuries, and many other factors. Impaired or impossible tear flow is caused by narrowing of the tear ducts or lacrimal sac due to inflammation and injuries, and in newborns, due to the existence of a single membrane in the draining tear ducts that disappears by itself under normal circumstances.
Symptoms:
The increased amount of tears flows down the face over the edge of the eyelid instead of towards the nose. As this encourages constant wiping of the eye and face, it can lead to redness of the eyelid and the eye itself, and in severe and long-lasting cases, the edge of the eyelid changes its position, making the joint more exposed to inflammation.
Establishing a diagnosis:
Based on a specialist examination, it can be determined whether there is irritation of the eye by external factors that could cause increased gland secretion. If this is not the case, an attempt is made to insert a probe into the tear ducts and spray them, which can clearly show if and where there is a narrowing. Spraying is a painless method in which pressurized liquid is “pushed” through the draining tear system, which can simultaneously push away or break through smaller blockages. An even more precise test is dacryocystography, a radiological test in which a contrast medium is injected into the ducts and then a picture is taken.
Treatment:
If the cause of tearing is eye irritation, then it should be stopped, depending on the cause, either by stopping staying in polluted areas or by treating diseases of the conjunctiva and cornea that cause these disturbances. Spraying and rinsing the canaliculi is useful in some cases, but in the case of a complete stoppage of the passage of tears, surgery is most often required.
In the newborn age, the membrane in the canaliculi is tried to be broken by firmly massaging the inner corner of the eye in the direction of the nose. If this technique does not give results, then a minor surgical procedure is performed, which is performed under general anesthesia due to the need for the child to be completely calm during it. With it, a special thin probe is introduced into the canals to reach the membrane and break through it. The operation has excellent results, and the narrowing disappears almost immediately.
Dry eye
Causes and origin of the disease:
Dry eye is caused by reduced tear production in the lacrimal gland. This happens most often in women around 50 years of age and later, which is related to hormonal changes, and much less often in men. The disease may be associated with disease of other systems, eg dry mouth in SjÅ’egren’s syndrome or rheumatoid arthritis. If it occurs independently, the cause is a disease of the lacrimal gland and/or a changed quality of tears, whereby they cover the eye more poorly and unevenly and evaporate more easily. Of course, hot dry air, nicotine and other factors have a negative impact.
If the disease has its repercussions only on the cornea, then it is called keratitis sicca (lat. Keratitis sicca), and if the consequences are also visible on the conjunctiva, then it is called keratoconjunctivitis sicca (lat. Keratoconjuncticitis sicca). The lack of tears, which have a protective role, causes drying of the eye and the creation of small defects on the surface of the cornea, as well as increased friction between the eyelids and the eye when blinking.
Symptoms:
Patients complain of dry eyes, feeling of sand in the eyes, redness and sometimes slight pain. Most of them themselves realize that they lack tears.
Establishing a diagnosis:
An examination in a specialist outpatient clinic can immediately assess whether the conjunctiva and cornea have dried out and been damaged. Schirmer’s test I is used to assess the amount of tears produced. In this test, one end of a test strip made of a special type of paper is placed in the junctional bag. The subject squints for 5 minutes, and after that time, the length of the strip wetted by tears is measured. A normal result is around 10-15 mm, and below 5 mm of wetted tape, the result is bad. Schirmer’s test II is performed in the same way except that the junction is anesthetized with drops of local anesthetic to prevent reflex tearing due to the insertion of the test strip. The result obtained shows only the basic secretion.
Treatment:
The lack of tears or their poorer quality is compensated by the instillation of artificial tears. These agents cover the surface of the eye and thus moisturize and protect it and reduce friction between the cornea and the eyelids. It is necessary to use them several times a day, on average 4-6 times, and the duration of the therapy is very long and depends on the cause of the decrease in the amount of tears. Artificial tear drops are not harmful or have any side effects even after years of use.
Inflammation of the lacrimal gland
Inflammation of the lacrimal gland (lat. Dacryoadenitis acuta) is most often caused by bacteria, but it can also be associated with other diseases.
The inflamed gland is visible as a thickening in the area of the outer part of the upper eyelid, which is accompanied by redness and is more painful to the touch.
It is treated with antibiotics, and the application of warm compresses is also useful.
Inflammation of the lacrimal sac
Causes and origin of the disease:
Inflammation of the lacrimal sac occurs when the flow of tears through the drainage channels is partially or completely stopped. In the secretion that accumulates in them, bacteria develop that cause purulent inflammation. It can develop very suddenly within 1-2 days, which is called acute dacryocystitis (lat. Dacryocystitis acuta) or be permanently present with alternating periods with stronger and weaker symptoms, which we call chronic dacryocystitis (lat. Dacryocystitis chronica).
Symptoms:
Acute inflammation begins with redness and swelling in the inner corner of the eye (the area closer to the nose). Purulent contents return to the nose through the tear ducts under pressure. Creation becomes bigger with time. The condition becomes extremely serious if the surrounding tissue of the orbit is also affected by the inflammation, and in these cases the body temperature is also elevated and there is pain when moving the eye. With a strong purulent process, the enlarged lacrimal sac and the skin above it sometimes burst and the pus comes out.
Chronic inflammation rarely has very pronounced inflammatory symptoms, but there is constant increased lacrimation of the eye and the return of contents when pressure is applied to the lacrimal sac.
Establishing a diagnosis:
The diagnosis is made on the basis of a clinical examination. By pressing a finger on the lacrimal sac, the mucous-purulent content comes out of the tear ducts. The location of the blockage can be determined indirectly by spraying the tear ducts or by dacryocystography if it is possible and necessary.
Treatment:
In case of acute inflammation, antibiotic therapy is required until the symptoms subside. If, after the inflammation subsides, there is residual narrowing of the tear ducts, you can try to widen them by spraying, but an operation will probably be necessary. Chronic dacryocystitis is treated in the same way.
The most common type of operation is dacryocystorhinostomy, in which the lacrimal sac is connected directly to the nasal mucosa and thus bridges the blockage. There are other types of operations, but they are used much less often. After the operation, the symptoms disappear and the normal path of tears is established, thus eliminating the conditions for new inflammation to occur.
Literature:
M.Sc. sc. Pavan Dr. Joško, “Eye Diseases”, Zagreb 2003.
