Ask a Doctor: What to do about extremely watery eyes

You can treat dry eyes with warm compresses or fish-oil supplements – Getty

Retired GP, journalist and author, Dr Le Fanu graduated from Cambridge University and Royal London Hospital in 1974 before working in the Renal Transplant Unit at the Royal Free and Cardiology Department at St Mary’s Hospital. For the past 20 years, he has combined medical practice with writing weekly for the Sunday Telegraph and Daily Telegraph. His book ‘The Rise and Fall of Modern Medicine’ won the Los Angeles Times Book Prize.

Dear Dr Le Fanu, 

“At times I can be almost blinded by tears. They fall profusely standing at the cooker or bending over in the garden. When out shopping I have to reassure people I am not crying as I feel for a handkerchief to dab my eyes.”

A:  We generate an astonishing 20 gallons of tears every year moisturising and nourishing the sensitive cornea, protecting it from the elements of wind and rain and flushing away any damaging dust or particles Their indispensable role in perceiving the world around us is necessarily compromised by the blurring tearfulness of the watery eye.

Making sense of the watery eye

The watery eye is common enough, especially in those in their 70s and beyond, affecting as many as one in five. The mechanics are quite complex, but clarified by appreciating there are two distinct types of tears.

The first are ‘basal tears’: the thin film moisturising the cornea which importantly consist of an aqueous layer generated by the lacrimal glands under the eyelids, and a protective outer oily layer, preventing its evaporation, secreted by the meibomian glands along the rim of the eyelids.

The second type are ‘reflex tears’ generated in abundance by the lacrimal glands in response to some external irritant: smoke, fumes, chemicals, dust and particles, viral and bacterial infections of the eye and pollen-induced inflammation in hay fever sufferers.

The explanation for those troubled with persistent watery eyes is quite different owing to, if paradoxically, a ‘dry eye’.

The paradox of ‘the watery dry eye’

The excessive tearfulness of the watery eye remained a mystery until it was realised that the fundamental defect lay in the outer oily layer stabilising and sealing the tear film. With age, the volume and consistency of those oily secretions diminishes and, without its protective seal, the aqueous layer beneath is lost because of evaporation. The eye becomes dry. This, in turn, triggers a compensatory outpouring of those reflex tears.

Treating the watery eye

The regular application of warm compresses to the eyes promotes the flow of oil from the meibomian glands, whose volume and consistency can be boosted by taking fish oil or omega-3 supplements. The mainstay of treatment however is the regular installation of ‘artificial tears’, carmellose sodium which, by hydrating the eye, inhibits the production of those reflex tears.

What else?

Waking with watery eyes

When asleep, the eyelids may not close, causing the eye to dry out completely overnight. The compensatory outflow of reflex tears upon waking can be minimised by applying a thin strip of lubricating ointment to the inner eyelids.

Watering on windy days

A strong cold wind exacerbates evaporation of the tear film hence the tendency to  watery eyes when out and about. This is avoided by wearing clear wrap around cycling glasses.

Blocked tear ducts 

Blockage (or narrowing) of the tear ducts in the corner of the eye prevents the tears from draining away through the back of the nose overflowing, instead resulting in a constant stream down the face. The blockage can be corrected by flushing the duct with a saline solution under pressure or it may require a corrective surgical procedure.

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