Most cases of conjunctivochalasis can be monitored, but once it causes a foreign body sensation or persistent epiphora, it should be surgically treated. If this is present, the patient requires a surgical procedure to tighten the conjunctival tissue via resection or cautery. 2 Conjunctivochalsis can often advance to the point of resting on the lower eyelid. One very important cause of excessive tearing is conjunctivochalsis, or folds in the conjunctiva due to a loss of Tenon’s. During your slit lamp exam look for a turned-in lash (trichiasis) that requires epilation or a foreign body.Ī diagnosis of ectropion, as seen here, may warrant surgical tightening. The first step is to rule out the non-dry eye causes. 1 Let’s look at all the potential causes. 22.4%) however, more men had eyelid malposition than women (39.5% vs. 1 It also showed that women tended to experience epiphora at a younger age than men and the primary cause of their epiphora was punctal stenosis compared with men (34.6% vs. A large-scale study showed that epiphora causes included lower lid malposition (33.3%), nasolacrimal/canalicular obstruction (29%), multifactorial (22%), punctal stenosis (11%) and reflex tearing (4.7%). 1 Four general categories include: (1) lid apposition issues, (2) nasolacrimal duct obstruction or stenosis, (3) dry eye disease and (4) a broad category we’ll define as something you’d see on a slit lamp examination such as trichiasis or allergic conjunctivitis. If it’s not caused by dry eye, the appropriate management or referral must be made.Įpiphora is typically a multifactorial issue with many causes. If it is caused by dry eye disease, or more specifically lipid layer deficiency causing the lacrimal gland to upregulate, then it becomes very important to educate the patient that their eyes are tearing due to a lack or decrease of one of the components of the tear film. It’s imperative that we first determine the cause of the epiphora so we can properly educate patients and provide them the best treatment options. Watery eyes, known as epiphora, seems like a misnomer for dry eye disease (DED), which can be very confusing to patients.