Itchy, Watery Eyes

According to the American Academy of Allergy, Asthma, and Immunology, allergic rhinitis affects between 10% and 30% of the population worldwide. Besides experiencing symptoms such as sneezing, congestion, and a runny nose, most of the affected individuals experience ocular symptoms such as swollen eyelids, redness, itching, and tearing.

Medically referred to as epiphora, watery eyes is often a symptom of seasonal allergies. Almost 50 million people in the United States are affected by seasonal allergies, with the common airborne allergen being tree and grass pollen.

Allergic rhinitis, which is characterized by a group of symptoms affecting the nose, is often accompanied by allergic conjunctivitis, which refers to the inflammation of the conjunctiva (the clear membrane that lines the sclera or the white part of the eye) due to the exposure to an allergen.

Besides pollen, exposure to mold, pet dander, house dust mites, poisonous plants (poison ivy, poison sumac), latex, etc., can also cause an allergic reaction. While excessive tearing and itching is mostly associated with allergies, these symptoms could also appear in individuals affected by eye infections or conditions related to the tear glands or ducts.

Tear production is extremely essential for keeping our eyes healthy. Tears not only keep our eyes moisturized, but also keep our vision clear by removing irritants. Under normal circumstances, tears are continuously being produced by tear glands (lacrimal glands) located in the outer corners of the eyelids.

They drain into puncta, which are tiny holes that are located in the corners of both the upper and lower eyelids. Small canals (canaliculi) in the eyelids move the tears to the lacrimal sacs (two dilated ends of the lacrimal ducts located at the nasal ends of the eyes).

Thereafter, the tears travel through the nasolacrimal duct. Around 90% of the tears are reabsorbed through the nasolacrimal duct mucosa, whereas 10% drain into the floor of the nasal cavity.

When we blink, the tears spread over the surface of the eye. This tear film moistens the eyes, thereby preventing eye infections and discomfort. The composition of tears is equally important. A tear is made up of sebum, water, and mucus.

The outermost layer contains sebum, which is an oily secretion that is produced by the meibomian glands that are located along the upper and lower eyelids. It is an essential ingredient of the tear film, as it prevents the tears from getting evaporated quickly.

Water, which is produced by the lacrimal glands located on the upper and outer portion of each eye, allows the tears to spread easily on the surface of the eyes. The innermost layer is made up of mucus. Mucus and water together facilitate the even distribution of tears.

The tear ducts that are located on the upper and lower eyelids facilitate the drainage of tears. If tear drainage or the quantity/quality of tears is adversely affected, eye problems such as redness, itching, tearing, etc., could arise.

Watering of eyes accompanied by itching could be associated with tear gland disorders. Dry eyes syndrome is a condition that is characterized by poor quality of tears along with decreased tear production. It is one of the common contributing factors for itchy and watery eyes.

Tears also contain an enzyme called lysozyme, which inhibits bacterial growth on the surface of the eye. Therefore, decreased tear production can make one susceptible to eye infections. Moreover, tears also help remove debris or any foreign material that enters the eye. The oil component of the tears prevents the tears from getting evaporated quickly.

Thus, if the balance of the three components of the tears is affected, it leads to dryness of the eye.

People affected by this condition are likely to experience symptoms such as:

➠ Gritty or foreign body sensation in the eyes
➠ Itchy eyes
➠ Pain
➠ Redness
➠ Temporarily blurred vision
➠ Burning sensation
➠ Increased sensitivity to light
➠ Excessive tearing
➠ Eye fatigue

When eyes dry out, the lacrimal gland starts producing more tears in order to relieve the dryness. People affected by this condition are more susceptible to eye infections, as poor tear film cannot quickly wash away the irritants and is unable to protect the eyes properly.

It must be noted that hormonal changes during menopause or medical conditions such as rheumatoid arthritis or Sjogren syndrome could make one susceptible to this condition. Improper use of contact lenses or being outdoors when it's too sunny or windy can also cause the eyes to become dry.

Blocked tear ducts or improper drainage of the tear ducts could also lead to the watering of the eyes. The tear ducts perform the task of moving excess water from the eyes to the nose. When the tear ducts get blocked, tears are unable to travel down the nose. As a result, they get accumulated in the eyes and start rolling down the cheeks.

These ducts could get blocked due to long-term use of certain topical eye medications or conditions such as eye infections, chronic nose infections, injury, or a nose polyp/tumor. This could give rise to symptoms such as tearing, crusted eyelashes, eye discharge, as well as increased susceptibility to infections.

The term 'conjunctivitis' refers to the inflammation of the conjunctiva, which is the tissue that coats the inside of the eyelid, as well as the white part of the eyeball. Commonly referred to as pink eye, this condition can be caused due to infections caused by viruses or bacteria, or contact with chemicals/irritants or allergens.

While redness or bloodshot eyes is the characteristic symptom of this condition, it also causes a host of symptoms such as:

➠ Watering of the eyes
➠ Itchy eyes
➠ Swollen eyelids
➠ Thick eye discharge (Bacterial conjunctivitis)
➠ Watery discharge (Viral conjunctivitis)
➠ Crusted eyelids
➠ Blurred vision
➠ Burning sensation in the eyes
➠ Increased sensitivity to light

Allergic conjunctivitis is quite common in individuals affected by seasonal allergies. An allergic reaction occurs when one comes in contact with allergens (substances that the immune system considers to be a threat) such as pollen, dust, chemicals, fumes, pet dander, etc.

When a person is exposed to a substance that the body regards as a foreign invader or threat, the mast cells release a chemical called histamine. It must be noted that the conjunctiva contains several mast cells.

Histamine secretion causes the blood vessels in the conjunctiva to dilate, thereby causing redness, puffy eyes, as well as itching and watering of the eyes. Watering of the eyes is generally our body's response to the presence of allergens or irritants, as more tears are produced in order to get rid of the irritants.

Irritation due to the ingrown eye lashes or the use of poor-quality eye makeup products could also lead to excessive tearing.

Consult an ophthalmologist at the earliest, if your eyes are red, itchy, and watery. Treatment will vary, depending on the underlying cause. In case of dry eyes, the treatment will involve:

➠ Administration of lubricants (eye drops, gels, or ointment) is often the first line of treatment for dry eyes. These lubricants are created, keeping in mind the natural composition of human tears. Restasis (Cyclosporine ophthalmic emulsion), an eye drop that is believed to promote tear production, might be recommended in severe cases.

➠ Dry eyes syndrome can put one at an increased risk of infection, which is why care must be taken to keep the eyes moisturized. One must also wear sunglasses to protect the eyes from harsh sun and wind.

➠ In severe cases, corticosteroids might be recommended to reduce inflammation.

➠ Since overuse or improper use of contact lenses can increase dryness, contact lens users must follow precautionary measures regarding contact lens usage.

➠ In some cases, small plugs called punctal plugs are used to seal the tear ducts, so that the tears don't drain into the tear ducts. Initially, temporary plugs that are made of silicone are implanted to see if this method works. If it does, permanent plugs are placed to increase the amount of tears on the surface.

Treatment mostly involves drug therapy in case of eye infections. It is essential to identify the underlying cause of infection.

➠ While viral conjunctivitis often resolves in a few days without treatment, antiviral drugs might be prescribed.

➠ Antibiotic eye drops need to be instilled in case the infection is caused by a bacterium.

➠ In case of an allergic reaction, antihistamines are prescribed to counter the effect of histamine (chemical released by the mast cells during an allergic reaction).

➠ Hand hygiene is extremely essential. Wash your hands with an antibacterial soap frequently, especially before touching the eyes.

➠ One must refrain from rubbing the eyes vigorously, as that could sometimes lead to abrasions on the surface of the cornea.

➠ Discard eye makeup products that are past their expiry date. Refrain from applying makeup or wearing contact lenses, if you have an eye infection.

Though watering of eyes might not be a cause of serious concern always, an ophthalmologist must be consulted, in case one has been experiencing symptoms such as redness, itchiness, and blurred vision. Sometimes, epiphora might be an early symptom of eye infections. If left untreated, this condition could worsen. Since eyes are very delicate, there should not be any delay in contacting an ophthalmologist in such cases.

Disclaimer:The information provided in this story is solely for educating the reader. It is not intended to be a substitute for the advice of an ophthalmologist/medical expert.