By Anthony L. Komaroff, M.D.

DEAR DOCTOR K:

I am 63 and have tears running down my face at odd times. What's going on, and what can I do about it?

DEAR READER:

Watery eyes are a common problem for adults. And there's often an effective treatment.

First, a little background. Tiny lacrimal glands (tear glands) are located above your eyes at the edge of your eye sockets. These glands are continually making small amounts of tears. Your tears keep your eyes from getting irritated by dust and dirt and help fend off infections.

But once the fluid has served its purpose, or if there's too much of it, your eyes need to get rid of the excess. When you blink, tears are pumped away from the eye through tiny tear ducts.

In my experience, watery eyes are usually caused by one of four problems.

-- Sometimes the openings to the tear ducts close up. If the duct opening is too small, your tears will have a hard time getting into the duct. That causes the tears to back up in the eye.

-- Often, though, the problem is a blockage farther down the tear duct. Unfortunately, the procedure to open blocked ducts isn't a minor one. Surgeons must create a little passageway around the blockage while you are under general anesthesia.

-- A third reason for watery eyes is, ironically, dry eyes. Dry eyes are caused by conditions that cause the tear glands to make less tears than are needed. Sometimes these glands just get old and tired, as we do. Certain diseases cause the immune system to attack the glands, reducing their ability to make tears. As a result, dry eyes can become irritated. If the irritation becomes too great, the tear glands can temporarily come to life. That causes a sudden gush of tears.

Over-the-counter "artificial tears" products often work quite well to relieve dry eyes. And relieving dry eyes can then eliminate the sudden gush of tears. When the dry eye is caused by an attack of your immune system on the gland, a powerful drug, cyclosporine, can work when other treatments don't.

-- Finally, you can develop a watery eye if your lower eyelid droops away from the eye. When this happens, tears accumulate on the surface of the eye. This condition is easily fixed by surgically tightening the eyelids. I just had a patient go through this minor surgery last month, and it fixed his problem.

When eye surgery is needed, ask your doctor to recommend a special kind of eye doctor. Because medicine is becoming more and more specialized, a general eye doctor (ophthalmologist) may not be enough. You may need a special type of ophthalmologist called an oculoplastic specialist, who has done additional training in eyelid and tear duct surgery. This doctor will determine what's causing your eyes to water and will help choose the right treatment for you. The chances are good that your watery eye problem can be fixed.

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Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.

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