The Dry Eye Zone

Rebecca's Blog

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Abstract: Dry eye and over-tearing

This is really rather interesting. You've got a whole bunch of people who have been referred to the oculoplasts (specialists that cut up eyelids, among other things) because of excess tearing, presumably so referred on the assumption that the patients' tear drains (nasolacrimal ducts) are obstructed - but in nearly half the cases, it was dry eye causing the tearing.

Who was referring all these people? This really underscores the need for education about excess reflex tearing as a dry eye symptom. It's understandable that PATIENTS don't realize on their own that wet eyes can be caused by dry eyes (it's not a little counterintuitive until you understand the mechanism), but some GPs, optometrists and ophthalmologists may need some reminding about this as well.

Etiology of Tearing: A Retrospective Analysis of Referrals to a Tertiary Care Oculoplastics Practice.
Ophthal Plast Reconstr Surg. 2010 Oct 11. [Epub ahead of print]
Mainville N, Jordan DR.
Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada.

PURPOSE: To determine the etiology of tearing among referrals to a tertiary care ophthalmology practice specializing in oculoplastics.

METHODS: A retrospective chart review was conducted of 150 consecutive referrals to our practice for tearing. The main diagnosis was noted in all cases as well as treatment offered and response to therapy. An anatomical approach was used to classify the tearing etiology. The categories included the following: dry eye with reflex tearing, tear hypersecretion, ocular surface disease (e.g., pterygium, pinguecula), lid abnormalities (e.g., entropion, ectropion), upper lacrimal system (e.g., punctal stenosis, canalicular block), and lower lacrimal system (e.g., dacryocystitis, dacryostenosis, nasolacrimal duct obstruction).

RESULTS: Review of the charts of 150 consecutive pts referred for tearing revealed that although the most common etiology was obstruction of the nasolacrimal system, dry eye with reflex tearing was almost as common. Specifically, 48.7% (n = 73) had a blockage of the lacrimal system (8% [n = 12] upper system, 40.7 [n = 61] lower system), 40% (n = 60) were felt to have dry eye with reflex tearing, 6.7% (n = 10 patients) had a lid abnormality, 1.3% (n = 2 patients) had lacrimal hypersecretion, 0.7% (n = 1 patient) had ocular surface disease, and 2.7% (n = 4 patients) had a normal lacrimal system on exam.

CONCLUSIONS: Our retrospective review of a series of patients referred to our practice for tearing revealed a significant proportion of patients whose tearing etiology was other than a nasolacrimal duct obstruction. Of particular interest is the fact that 40% of patients had dry eye with reflex tearing, and the majority of these improved with lubrication. These patients were all identified by performing a Schirmer test to quantify the basal tear production. We believe that the Schirmer test is a useful diagnostic tool in assessing patients with tearing and ensuring that the appropriate management approach is undertaken.
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