Why We Cry

Actually today's post is about "epiphora" or excessive tearing. It's one of the most common complaints we get, and unfortunately one of the most UNSOLVABLE ones.

It makes me laugh when you look up "epiphora" on the internet. There are literally dozens of causes, ranging from allergies to dry eye to contact lenses to conjunctivitis...even GLAUCOMA is listed as a possible (but highly improbable) cause of excessive tearing. So let me break it down into a little real world medicine here:

The vast majority of patients complaining of CHRONIC excessive tearing are over about 50 years of age. Sure when a 12 year old complains of ACUTE tearing I'm thinking possible allergies, but when an 85 year old is mentioning that they deal with it all day every day, it's probably something else.

In said patients over 50, frequently the cause of the tearing is a problem with the punctum or tear-drainage-hole on the lower eyelid near the inner corner. The punctum can become "stenosed" or clenched shut from aging. It can be re-opened with an in-office procedure (punctal dilation), but the procedure can be somewhat uncomfortable, and it frequently re-closes.

Another common cause of excessive tearing in patients over 50 is that the punctum doesn't face "up" anymore; the eyelid margin has turned in (entropion) or is lax & turns out (ectropion). Again this is not easy to fix. A reconstructive eyelid surgery can sometimes help, but it's expensive, its real/bonafide surgery, and sometimes it doesn't work. No guarantees.

So what is to be done? Well there's no easy fix. There are a lot of palliative treatments with varying degrees of success: antihistamine eyedrops to try & eliminate an allergic component, artificial tears to try & alleviate a dryness or tear film evaporative problem (that leads to "reflex" tearing), etc. But there is no one "fix all" treatment for epiphora, unfortunately. You end up having to weigh the inconvenience of your tearing vs the risk & potential (but not guaranteed) reward of surgical procedures. Hey, that's the 2nd blog post in a row that mentions risk/reward. It's a common theme in medicine.


  1. Hello. Is -7.00 for the right eye and -6.25 for the left eye considered severe nearsightedness?

    Also, do pinhole spectacles help improve vision?

  2. "Hello. Is -7.00 for the right eye and -6.25 for the left eye considered severe nearsightedness?"


    "Also, do pinhole spectacles help improve vision?"



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