Dacryorrhea is the medical term for the symptom of excessive tearing. This condition is not a disease in itself but a sign that the balance of tear production and drainage has been disrupted. People with dacryorrhea experience tears constantly pooling on the eye’s surface or overflowing onto the cheek (epiphora). Understanding the underlying cause is the first step toward effective relief.
The Mechanism of Excessive Tearing
Normal tear flow relies on a finely tuned “plumbing” system to keep the eyes lubricated without overflowing. Tears are continuously produced by the lacrimal gland, located above the outer corner of the eye. After spreading across the eye’s surface with each blink, tears drain out through two tiny openings, called puncta, found on the inner edge of the upper and lower eyelids.
Tears then travel through small tubes called canaliculi, into the lacrimal sac, and finally down the nasolacrimal duct, which empties into the nasal cavity. Dacryorrhea occurs when this process is unbalanced, resulting from either hypersecretion or impaired drainage. Hypersecretion is a reflex response where the eye produces a flood of tears to flush out an irritant or injury. Impaired drainage is a mechanical issue, such as a blockage, preventing the normal exit of tears.
Primary Causes of Dacryorrhea
Causes of excessive tearing separate into those that stimulate overproduction (hypersecretion) and those that obstruct the drainage pathway (impaired drainage). Hypersecretion is frequently triggered by external factors that irritate the ocular surface, such as wind, smoke, dust, and foreign bodies. Allergic reactions, often to pollen or pet dander, also lead to increased tear secretion as the body attempts to wash away allergens.
Paradoxically, severe dry eye syndrome can cause hypersecretion when dryness triggers the lacrimal gland to produce a large volume of reflex tears. Infections like conjunctivitis also result in increased tear flow as the body tries to cleanse the eye of pathogens.
Impaired drainage is often caused by a physical obstruction within the lacrimal system, most commonly in the nasolacrimal duct. This blockage can be congenital or acquired later in life due to chronic inflammation, scarring, or age-related narrowing. Drainage failure can also result from incorrect eyelid positioning. Ectropion (an outward-turning lower lid) or entropion (an inward-turning lower lid) prevent the puncta from properly contacting the eye, disrupting the natural pump action needed to draw tears into the system.
Diagnosis and Management Options
Medical evaluation for dacryorrhea typically begins with a detailed history and a comprehensive eye examination using a slit lamp microscope. To determine if the issue is a drainage problem, a simple, non-invasive procedure called the fluorescein dye disappearance test is often performed. A small amount of fluorescein dye is placed in the eye, and if a significant amount remains after five minutes, it suggests the tears are not draining correctly.
Further diagnostic steps may include probing and irrigation, where a saline solution is flushed through the drainage system to check for patency and identify the location of any blockage. The management strategy is always determined by the identified cause of the excessive tearing. If hypersecretion is the cause, treatment focuses on the underlying trigger, which may include medicated drops for allergies or antibiotics for bacterial infections.
For impaired drainage, non-surgical options like a lacrimal massage technique may be recommended, particularly for infants with congenital blockages. Chronic or severe drainage issues, especially a complete obstruction of the nasolacrimal duct, often require a surgical procedure called dacryocystorhinostomy (DCR).
DCR creates a new permanent pathway between the lacrimal sac and the nasal cavity, effectively bypassing the blocked duct. The DCR procedure can be performed externally through a small incision near the nose or endoscopically through the nasal cavity. For severe blockages high in the drainage system, a temporary silicone stent may be placed to keep the new opening from closing during the healing process. Individuals experiencing persistent tearing, pain, or any associated changes in vision should consult a medical professional to rule out more serious conditions.