Watery Eyes - What causes them and when should you worry? 

Lance Alexander (0:01)

Best of Live Well ft. Lance Alexander.

Good morning Singapore. Watery eyes are usually associated with crying, allergies or irritation. But what if your eyes keep tearing up for no apparent reason? One possible cause is a blocked tear duct. When tears cannot drain properly, they may cause blurred vision, and in some cases, that could lead to an infection. At the National University Hospital, doctors are using a minimally invasive procedure that allows them to see inside the tear drainage system and clear certain blockages without creating a new drainage pathway. To tell us more, we have Dr. Maryanne Chew Romero, consultant, Department of Ophthalmology, National University Hospital and Alexandra Hospital.

Doctor, welcome to the show.

Maryanne Chew Romero (0:53)

Thank you. Thank you for having me.

Lance Alexander (0:55)

My pleasure. Now, firstly, congrats to NUH for celebrating 40 years. So as we celebrate four decades of transforming eye care, let's bring some clarity as we try to understand why people get watery eyes. Yes, they are, like I said, allergies, irritation, maybe you get a bit emotional, you cry. But what causes persistent watery eyes?

Maryanne Chew Romero (1:18)

Okay.

So I think tearing is actually, or watery eyes is actually a very common problem, especially as patients get older. And if you think about a teary or watery eye, it's usually from two main causes. I would say that the first cause is that your eyes are producing too much tears. And then on the other...

Lance Alexander (1:35)

Is it a bad thing?

Maryanne Chew Romero (1:36)

Yeah, it can be.

Lance Alexander (1:37)

Oh, okay.

Maryanne Chew Romero (1:38)

When you have too much tears, it becomes actually patients get quite bothered. And then on the other spectrum, you have patients who have an issue with draining the tears. So it's either an overproduction kind of problem, or you have a drainage kind of problem. So when we look at problems or issues causing overproduction, usually that's something that it's a condition where the eyes are irritated, either from allergies or from the haze recently, or patients with certain eyelid problems where the eyelid is not sitting on the eye properly, or they have severe dry eyes. These are issues that can actually trigger a lot of tearing.

But if you have a tearing that is associated with persistent discharge, now that is when you need to consider a drainage problem as an underlying cause. So a blocked tear duct certainly can cause tearing with quite a lot of discharge.

Lance Alexander (2:32)

When you say there's a lot of tearing as well, how do we know whether it's too much? Because sometimes you wake up in the morning and your eyes seem a bit watery, or after staring at the computer screen for a while, you go, oh, my eyes are just getting a bit tired and they're getting a bit watery. When do you know, oh, you need to go and see a specialist or doctor?

Maryanne Chew Romero (2:50)

I think any time you find that it is interfering with your normal activities, you find that it's interfering with your driving, your work, your hobbies, your interactions with people, I think that's when, you know, certainly you should see it. It doesn't matter if it ends up being something as people think that dry eyes is trivial, right? But actually, no, it can really be quite, can be a big issue for patients. So certainly I find that if any time it's interfering with your daily life, you should certainly get it checked.

Lance Alexander (3:19)

It's rather contrarian because dry eyes can also cause excessive tearing. How does that happen?

Maryanne Chew Romero (3:24)

Yeah. And I think that's that paradox that a lot of patients actually, they don't quite understand. So that's what we call reflex tearing. When dry eyes actually stimulates your eyes to produce more tears, but the tears, they're not doing what they're supposed to do. There's a gush of tears and it coats the eye for a while, but it doesn't have the stability of a normal tear film to stay on the eye. So that really is one cause of tearing.

Lance Alexander (3:52)

How can someone tell whether they have dry eyes or a blocked tear duct?

Maryanne Chew Romero (3:56)

It is sometimes difficult. I think one of the key differences in terms of symptoms would be discharge. So for example, if you have tearing, one-sided tearing, for example, with quite a lot of discharge associated, or if you start developing a swelling in the inner corner of your eye, I think that's when you need to think about a blocked tear duct as a cause.

Lance Alexander (4:19)