Tearing Disorders and Eyelid Malposition

Tearing Disorders and Eyelid Malposition

Tearing Disorders and Eyelid Malposition

Tears are constantly produced by the lacrimal glands located above both eyes. Tears lubricate, clean, and protect the eyes. But excessive tearing, known clinically as epiphora, occurs when there is an overproduction of tears or when the eyes’ drainage system is malfunctioning.

There can be many causes behind excessive tearing. We cover problems with clogged tear ducts and other issues with drainage in the Lacrimal Surgery page of this site. These are other causes of excessive tear production in both adults and children.

  • Bacterial keratitis
    Bacterial keratitis is an infection of the cornea, the clear, dome-shaped lens on the front of the eye. Most commonly caused by staphylococcus aureus or pseudomonas aeruginosea bacteria, if these infections aren’t treated they can lead to blindness.
  • Bell’s palsy
    Bell’s palsy is a nerve disorder that affects the facial muscles in adults. A person with Bell’s palsy may not be able to properly close the eyelids, causing tearing.
  • Conjunctivitis
    Known commonly as “pink eye,” this occurs when the conjunctiva (the white area) is infected or reacting to allergies. Conjunctivitis is especially prevalent in schools, leading to kids missing 164 million school days each year in U.S. public schools. There are three kinds of conjunctivitis: bacterial (the highly contagious form), viral (also very contagious and caused by the same virus that causes the common cold), and allergic (not contagious, but caused by the reaction to an allergen or irritant).
  • Corneal abrasions
    If the cornea is scratched or scraped, it will lead to excessive tearing as the eye begins the process of repairing the damage.
  • Corneal lacerations
    When the cornea is cut, usually by something flying into the eye or from an object striking the eye with significant force, this is a very serious injury. Immediate medical attention is required to avoid vision loss. Once the injury has occurred, protect the eye with a shield or safety goggles. Do not remove the object and do not rinse the eyes with anything. Do not apply any pressure to the eye.
  • Corneal ulcers
    A corneal ulcer is an open sore on the cornea. It is usually the result of various sorts of eye infections, some of which are due to improper care when using contact lenses, which can lead to bacterial or fungal infections. Dry eye and Bell’s palsy can also cause these ulcers.
  • Dry eye
    Contrary to the name, dry eye can make your eyes tear intensely. Dry eye is a condition where your eyes are not producing enough tears, or are not producing the right kind of tears. Dry eye occurs mainly in adults, more often in women after menopause (usually when the tears are missing one of their three components: oil, water, or mucus). The eyes feel scratchy or gritty. They sting and burn. They are red, and tear a lot.
  • Eye allergies
    Eye allergies, a reaction to an irritant where the eyes produce histamine, make the eyelids and the conjunctiva (whites) red, swollen, and itchy. These allergies can come from a variety of sources — pet dander to perfume to some foods.
  • Fungal keratitis
    This is a fungal infection of the cornea. Fungal keratitis can develop after an eye injury or from improper contact lens use. This is more common in humid climates where the cornea can come in contact with plant matter, such as a palm frond brushing the eye. If not treated, it can lead to blindness.
  • Herpes keratitis
    This viral infection of the eye is caused by the herpes simplex virus. Type 1 is more common and also causes cold sores or fever blisters. Type 2 is sexually transmitted and is less common in the eyes. This viral infection comes after a person has touched an active lesion and then their eye.
  • Styes and chalazions
    Styes are small, painful lumps that grow from the base of the eyelash (usually due to an infection in the hair follicle) or on the inside of the eyelid (usually due to a infection in an oil gland). A chalazion is a swollen bump on the eyelid caused by a clogged oil gland. It may start as in internal stye and then harden into a chalazion. Both will cause extra tearing in the eye affected.

Eyelid Malposition — Entropion and Ectopion

Sometimes the eyelids can become incorrectly positioned. Two conditions describe whether the eyelid has turned inward, entropion, or whether the eyelid has turned outward, ectropion. The two conditions are often due to simple aging; surgery is the usual preferred treatment.


This is an eye condition where the eyelid turns outward. It typically affects the lower eyelid and can expose one section of the lid or the entire lid. It usually impacts older adults when the muscles, tendons, and connective tissue in the eyes have weakened. If a person has had trauma to the face or eyes, there is a higher chance of developing ectropion. Because the eyelid won’t properly help route and drain tears, it results in continuing irritation to the eyes.

While aging is the main cause of ectropion, there are others causes:

  • Eyelid growths
  • Previous eyelid cosmetic surgery
  • Facial scarring from burns or trauma
  • Excessive sun exposure
  • Cosmetic laser skin resurfacing
  • Facial paralysis due to Bell’s palsy
  • Radiation of the eyelid to treat cancer
  • Use of certain medical eye drops to treat glaucoma

Symptoms and complications of ectropion

Because ectropion inhibits proper tear draining, symptoms include eye irritation and redness, excessive tearing, pain, sensitivity to light, inflammation, and a gritty feeling in the eyes. In more severe cases, complications such as corneal abrasions, corneal ulcers, and eye infections can occur.
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Treating ectropion

There are temporary treatments such as artificial tears and ointments, but for ectropion due to muscle and tissue weakness surgery by the team at the Eye Institute at the Medical Center Clinic is the solution. This surgery may involve stretching of scar tissue, removing a small section of the eyelid, or a skin graft to reposition the eyelid.
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The opposite of ectropion, with entropion the eyelid turns inward. Entropion usually occurs on the lower eyelid and the skin and eyelashes painfully rub against the cornea. In entropion the patient’s eyelid can be rolled inward continually or only when the eyelids are closed tightly.

Like ectropion, entropion is usually a result of aging as the muscles around the eyes become weaker, but there are also other causes:

  • Injury
  • Congenital defect
  • Muscle weakness
  • Prior surgery
  • Inflammation
  • Skin disease

Symptoms and complications of entropion

Despite the eyelid being turned the opposite direction, symptoms of entropion are similar to those of ectropion: eye pain, redness, irritation, dry eyes, excessive tearing, sensitivity to light, reduced vision, discharge from the eye, and a feeling that there is something in the eye. As with untreated ectropion, entropion can lead to corneal abrasions, ulcers, and infections.
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With entropion, surgery is usually the best solution, although Botox injections have shown promise for relaxing the muscle spasms that can roll the lid inward. In the surgery, if the condition is caused by muscle weakness a small section of the eyelid is removed to tighten the muscles in the area. If the problem is tied to scars or prior surgery, a skin graft may be used to reposition the eyelid.
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