Why Do My Eyes Bother Me?

Dry eye and tearing are not a natural part of growing older.  They are conditions that are treatable when diagnosed accurately.

Where Do Tears Come From

Tearing is rarely the result of excessive formation of tears.  This is a very uncommon condition.  Tears may be produced by the tear gland.  These are reflex tears that are produced secondary to noxious physical or psychological stimuli.  Crying resulting from eye irritation or sorrow is very normal. Tears are also produced by the conjunctiva-the mucous membrane surrounding the white of the eye.  These are basic tears and are essential for proper visual function.  They are being constantly produced and are essential for proper visual function.

Where Do Tears Go

Tears are drained from the eye into the nose.  When the eyelids blink they pump the tears from the eye into a drainage hole in each eyelid called the punctum.  The punctum opens into a tube called the canaliculus which serves as a conduit to drain the tears from the punctum to the tear sac.  The tears flow thru the tear sac into the nose via the naso-lacrimal duct.  If this drainage system is interrupted at any point pathologic and symptomatic tearing will likely occur. This can be easily determined by a competent examination of the tear drainage system.

Eyelid Rolling Forward

If the punctum (the tear drainage hole) is not inthe appropriate postion the tears cannot be properly drained and tearing will occur. This abnormality may be very obvious be also might be very subtle.   Tearing may also result if the eyelids are just too weak to pump the tears into the punctum even if it is in the appropriate position.   This is called eyelid laxity and results from aging or trauma.  In addition to tearing these patients may also have a uncomfortable, chronic scratchy feeling in their eyes with or without a ropey discharge.  This is known as floppy eyelid syndrome and is readily diagnosed with special stains. This is a very common finding in people with sleep apnea and can even lead us to the diagnosis of sleep apena in some patients.

All of these eyelid abnormalities are easily diagnosed and treated if the eye doctor is aware of them, looks carefully and uses special stains to facilitate the examination.  Surgically tightening the eyelids is a minimally invasive procedure and very successful in skilled hands.

Tear Duct Blockage

Blockage of the canaliculus may be more of a problem.  The canal may be blocked by infection (canaliculitis), a foreign body (punctual plug previously placed for dry eye) or lacerated by trauma.  All these problems are treatable, some easily and some with great difficulty.  Patients with blockage of only one canaliculus may be asymptomatic.  Blockage of both upper and lower canaliculi invariably causes symptomatic tearing. The tear sac or tear duct may be scarred by infection, blocked by stones (dacryoliths), injured by trauma or invaded by tumors.  A blocked tear sac or duct is a set up for infection (dacryocystitis).  This is painful and if inappropriately treated may spread infection to the orbital contents causing orbital cellulitis a potentially blinding or lethal infection. Treatment entails incising the skin and sac and draining the infection.  Followed by a course of systemic antibiotics.   The tear drainage system can be later reconstructed by rerouting the lacrimal sac to drain into a different area of the nose.

In summary, you do not have to tolerate abnormal tearing (epiphora).   Doctors with expertise in this area of ophthalmology can usually easily manage these problems either in the office or in an out patient surgical center.  Dr. Spoor, Dr. Abrams, and Dr. Levy  are very experienced in dry eye and tearing problems. Drs. Spoor and Abrams have shared there expertise with other ophthalmologists by teaching courses at the American Academy of Ophthalmology.  Dr Abrams is available in all the SRI offices.  Dr. Spoor is available in the Sarasota office and in his office in suburban Detroit.

Please contact our office at 941-921-5335 to make an appointment to come in and start down the path of relief.


Tom Spoor, MD

Oculoplastics and Neuro-Ophthalmology

Sarasota, Florida

Detroit, Michigan 




  1. […] week we will explore the opposite of tearing-dry eye.  Dry eye is a very common condition, present in over 30% of the adult population.  In a […]

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