Tearing

What is it?

Too much watery discharge coming from eyes
Caused by too many tears being produced or too few tears being drained
Ocular allergy common cause
Any ocular inflammation, including dry eye syndrome, causes excess reflex tearing
Poor lid apposition to eye keeps tears from reaching punctum
Blocked canaliculus, lacrimal sac, or nasal passage can account for impaired drainage

How does it appear?

Patient reports tears draining onto cheek
Patient reports periocular pain or discomfort if inflammation cause of tearing
Hyperemia of conjunctiva
Corneal surface abnormalities from foreign body, inflammation, dry eye syndrome
Signs of scleritis, anterior uveitis, or acute glaucoma
Misdirected eyelashes coming from in-turned lid ("entropion")
Poor lower lid apposition ("ectropion")

What else looks like it?

Normal tearing, BUT...tears do not drop onto cheek except on windy, cold days, or as part of crying

What to do?

Check for corneal surface erosion by instilling fluorescein dye
Check for conjunctival redness, cloudy cornea, irregular pupil, or hypopyon
Inquire about allergy, trauma, sinonasal tumor, previous head radiation treatment, and previous or ongoing inflammation of eyes, sinuses, nose
Refer non-urgently to ophthalmologist

What will happen?

Prompt diagnosis important to relieve symptoms and prevent irreversible disability