What Causes My Eyes to Tear?

Tears are such an interesting product of the human body. I’m going to admit that I recently cried during a movie, and it’s a movie I watch a lot. The same part always brings tears to my eyes. When James Bond crashes his beautiful Aston Martin in Casino Royale always gets me! But in all seriousness, tears and tearing can be an expression of sadness or joy, malposition of the lower eyelids, dryness of the cornea, or an obstructed lacrimal system.

Having done fellowships in Oculoplastic and lacrimal surgery, I have seen the detailed workings of the lacrimal system both from the eyelid side and from the nasal side. During my fellowship, I spent a lot of time looking in people’s noses to see if nasal anatomy might be contributing to the tearing problems, and to see if they were candidates for surgery.

When a patient’s tearing is caused by an obstruction of the nasolacrimal duct that means the tears that are produced in the lacrimal gland can’t drain from the eyelid to the nose in the path that they were meant to.

There are two main approaches to treating these obstructions, one called an “open” approach and the other “endoscopic”. Both involve removing a little bit of bone that separates the orbit and the nose and rerouting the lachrymal system. The open approach is done by making an external incision onto the side bridge of the nose allowing for direct visualization by the surgeon of the eyelid and nasal anatomy so that the system can be redirected in the correct direction. The second method is actually by looking into the nose, finding the lacrimal bone, removing a small portion of bone, and using an endoscope to visualize the anatomy of the lacrimal system. Both of these methods are highly successful and yield great results. The decision to do the procedure using the open method (with an external incision) versus endoscopically is usually based on the patient’s nasal anatomy and radiographic imaging.

So the next time you find yourself tearing up, and a sad movie isn’t playing, consider talking to the eyelid expert to see if we have a solution to your tearing!

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