Practice 10-Minute Consultation

The Watery Eye

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d4029 (Published 19 July 2011) Cite this as: BMJ 2011;343:d4029
  1. Esmaeil M Arbabi, specialty registrar in ophthalmology1,
  2. Faisal A Arshad, specialty registrar in ENT2,
  3. Kate Holden, general practitioner3,
  4. Zia I Carrim, specialty registrar in ophthalmology1
  1. 1St James’s University Hospital, Leeds LS9 7TF, UK
  2. 2Royal Hallamshire Hospital, Sheffield, UK
  3. 3Haxby and Wigginton Health Centre, York, UK
  1. Correspondence to: Esmaeil M Arbabi esarbabi{at}gmail.com
  • Accepted 28 March 2011

A 58 year old woman complains to her general practitioner of watery eyes of several months’ duration. She finds the problem embarrassing, and symptoms are particularly bad on cold windy days.

What you should cover

The normal tear film provides lubrication, nourishment, and protection to the ocular surface. When healthy, it is made up mainly of a watery component produced by the lacrimal gland. Lacrimal gland function is under autonomic control and is also modulated by neuronal feedback from the ocular surface. A watery eye reflects an imbalance between tear outflow and production and is often multifactorial (see figure).

Causes of watery eyes and their management

History

Ask about:

Onset, duration, and the affected side(s)

Whether symptoms are predominantly indoors or outdoors—Indoor symptoms are usually more disabling.

Triggering or aggravating factors—These promote ocular surface dryness and irritation thereby increasing reflex lacrimation. Cold windy weather, dusty working environments, and activities requiring prolonged periods of concentration are examples.

Associated symptoms—Grittiness …

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