Management of the Watery Eye
Definition of watering of the eye:-
It is the symptom of flow of tears over the cheeks.
I. Lacrimation: Excessive tear production.
II. Epiphora: Defective tear drainage.
Clinical differences between lacrimation and epiphora:
I. Management of lacrimation:-
1. Reflex lacrimation in cases of:
- Corneal ulcers and iridocyclitis.
- Corneal foreign body or rubbing lashes.
- Buphthalmos and acute congestive glaucoma.
- Conjunctivitis especially spring catarrhal.
- Bright light.
3. Parasympathomimetic drugs as pilocarpine and eserine.
5. with yawning, vomiting and sneezing.
Type of patient:-
- Infants: Buphthalmos, ophthalmia neonatorum & corneal ulcers.
- Young adults: Iridocyclitis.
- Old diabetic: Corneal ulcers.
- Hypermetropic female above the age of 40 years: Acute glaucoma.
History and symptoms:-
- Foreign body sensation in cases of trichiasis and foreign bodies.
- Dull aching pain in iridocyclitis.
- Pricky pain increases by lid movement in corneal ulcer.
- Marked photophobia in buphthalmos, spring catarrhal, corneal ulcers and iridocyclitis.
b. Redness due to:
- Ciliary injection in corneal ulcer, iridocyclitis & acute glaucoma.
- Conjunctival injection in conjunctivitis.
c. Drop of vision in intraocular diseases as corneal ulcer, iridocyclitis and acute glaucoma.
d. History of drugs or emotional troubles.
a. Examination of lids for rubbing lashes and blepharitis.
b. Examine the conjunctiva for ciliary and conjunctival injection.
c. Examine the cornea for ulcers (fluorescein stain) or KPs. Corneal diameter is measured in children.
d. Examine the anterior chamber for flare, cells & hypopyon.
e. Examine the IOP: It is elevated in acute glaucoma and buphthalmos.
Treatment: Treatment of the etiology (mention in brief).
II. Management of a case of epiphora:-
Causes of epiphora:
1. Causes in the lids:
2. Lacrimal punctum obstruction:
- Post traumatic or postinflammatory as ulcerative blepharitis and trachoma.
3. Canalicular obstruction:
- Complication of chronic dacryocystitis (the commonest).
- Fungal canaliculitis.
4. causes in the sac:
- Acute and chronic dacryocystitis, pyocele or mucocele.
- After dacryocystectomy.
5. NLD obstruction:
Congenital and acquired (mention)
6. Nasal causes.
NB. The most important causes of watering of the eye in early childhood are: ophthalmia neonatorum, buphthalmos and congenital dacryocystitis.
- Examination of the posterior lid margin for ectropion.
- Examination of puncti for occlusion.
- Examination of canaliculi may show a foreign bodies or swelling.
- Examination of the sac for:
* Sac swelling.
* Regurge test (pressure below MPL):
- Regurge of clear tears indicates no infection.
- Regurge of pus means severe infection.
- Negative regurge means mucocele or pyocele.
Investigations (mention the details):
I. To confirm obstruction:
1. Fluorescein clearance test.
2. John's dye test.
II. To identify the site and cause of obstruction:
2. Irrigation with saline.
3. Irrigation with saline with adrenaline.
4. Radiography as plain X - ray & dacryocystography.
5. ENT examination.
III. To identify the causative organism:
Culture and sensitivity test.
I. Medical treatment:-
1. Systemic and local antibiotic if there is infection.
2. Nasal and conjunctival decongestant drops.
II. Surgical treatment depending on the cause of epiphora:-
1. Treatment of ectropion.
2. Treatment of punctal occlusion by excision of a triangle from its posterior wall (three snip operation).
3. Canalicular obstruction is treated by DCR + intubation of canaliculi (CDCR).
4. Chronic dacryocystitis is treated by .... (mention treatment of congenital and acquired cases).