Tear Jerkers

If I am not watching Hope Floats (with Sandra Bullock) or any movie starring Julia Roberts, why are my eyes tearing? The ophthalmic term for inappropriate tearing is Epiphora. What a beautiful Greek word for such a tragic phenomenon. I had a middle-aged Latino patient once in residency whom I will never forget. "Doctora, I wake up in the morning, I cry, cry, cry; I go to work, I cry, cry, cry; I go outside, I cry, cry, cry," he said to me. Tears were welling in his eyes as he spoke, and I felt great sadness at his predicament. Though he was not depressed, his eyes seemed to water wherever he went. Why?

There are two main reasons for epiphora: (1) a reflexive response to dry eyes, and (2) obstructed tear-ducts that do not drain properly. Obstructed tear ducts are self explanatory: tears build up in the eye and then run down one's face, because the drains are jammed up. The dry eye scenerio is a little more complex. "How can my eyes be DRY, if they are constantly WATERING?" My patients sneer at me with disbelief (sending concerned looks at my medical diploma and furtively eying my license to practice medicine).

The sophisticated and highly sensitive nerves on your cornea have moisture sensors that set off a reflex arc to the brain that then dispatches a message to your eyelids: "release tears, ahoy!" When the cornea becomes dry enough to set off this sprinkler system, tears gush down inappropriately. You may have experienced this phenomenon when the cold, dry winds of the Northeast have blown into helpless corneas, sending tears streaming down your cheeks. Perhaps you also cried with longing for the day you would move to a tropical island (a confounding factor), but I digress.

The way to treat obstructed tear-ducts is by having a dacryocystorhynostomy (duh!), which opens the ducts with silicone tubing and creates an alternative way for tears to drain into the nasal cavity. As for dry eyes, one treats the underlying problem (artificial tears, Restasis, lid hygene, etc.) How does one discern dry eyes from tear-duct obstruction? One squirts sterile water through the ducts at the chairside. If the squirtee can taste water in the back of his/her throat, the duct is open, and the cause is more likely dry eye syndrome. If s/he cannot taste the water, the duct is clogged. Incidently, a couple of my Russian patients requested a vodka substitute for the water in this procedure.

O.K., this is a wrap on epiphora. Put away your box of tissues.