Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. It can cause a wide range of symptoms, including vision problems like double vision, blurred vision, and eye pain. Some people with MS also experience watery eyes or excessive tear production (epiphora). There are a few potential explanations for why MS may lead to watery eyes in some patients.
Inflammation and nerve damage
One of the hallmarks of MS is inflammation and nerve damage in the central nervous system. This can disrupt signals between the brain and eyes, leading to problems with tear production and drainage. Some of the eye-related nerves that may be impacted include:
– Trigeminal nerve: Provides sensation to the eyes and face. Inflammation of this nerve can cause eye irritation and watering.
– Facial nerve: Controls tear gland secretion. Damage to this nerve may lead to excessive tear production.
– Optic nerve: Transmits visual information from the eyes to the brain. Optic neuritis, or inflammation of the optic nerve, is a common MS symptom and may be associated with watery eyes.
So in summary, inflammation and demyelination of nerves serving the eyes and tear system can lead to signaling problems, interfering with normal tear flow and causing watery eyes in some people with MS.
Medications
Some of the medications used to treat MS may also contribute to watery eyes as a side effect. For example:
– Corticosteroids: Steroids like prednisone are often used to treat acute MS relapses and may have ocular side effects like watery eyes.
– Disease-modifying therapies: Medications like interferon betas and glatiramer acetate are associated with tear duct side effects in some cases.
Always notify your doctor if you experience new onset or worsening eye symptoms after starting a new MS medication. An adjustment in dosage or different treatment may help manage medication-induced watery eyes.
Dry eye disease
Dry eye disease is a common comorbid condition in people with MS. One study found symptoms of dry eye in 60-70% of MS patients. Paradoxically, chronic dry eye can also lead to watery, irritated eyes as the tear glands struggle to compensate for lack of moisture.
Some contributing factors that make dry eye more likely with MS include:
– Nerve damage affecting blink reflex and tear distribution
– Use of anticholinergic medications that reduce tear production
– Reduced outdoor activity and vitamin D levels
Managing dry eye with lubricating drops, warm compresses, and lifestyle changes may improve watery eyes in some MS patients.
What Causes Watery Eyes?
Watery eyes occur when there is an imbalance in tear production or drainage. Some potential causes include:
Excessive tear production
– Eye irritation or infection causing reflex tearing
– Blocked tear ducts preventing drainage
– Trigeminal nerve dysfunction
– Overactive lacrimal (tear) glands
– Medication side effects
Impaired tear drainage
– Blocked tear ducts or nasolacrimal duct obstruction
– Problems with blink reflex and tear pumping
– Eyelid abnormalities or laxity
– Facial nerve palsy
– Scarring of the tear drainage system
Dry eyes
– Aqueous tear deficiency leading to irritated, watery eyes
– Meibomian gland dysfunction affecting tear film
– Chronic inflammation or autoimmune conditions
– Vitamin A deficiency
– Environmental conditions like wind or low humidity
So in summary, watery eyes occur due to either too many tears being produced or inadequate drainage of tears away from the eye surface. The specific cause helps determine appropriate treatments.
Treatments for Watery Eyes
The treatment for watery eyes depends on the underlying cause. Here are some common treatment approaches:
Nasolacrimal duct blockage
– Nasolacrimal duct probing or stenting: Opening up blocked tear drainage
– Dacryocystorhinostomy (DCR): Surgery to create artificial drainage passageway
Medications
– Reducing prescription eye drop frequency if overuse is the cause
– Changing or discontinuing medication if a side effect
– Prescribing anti-inflammatory eye drops (steroids, nonsteroidals)
– Using cholinergic agents to reduce tear production
Dry eyes treatments
– Artificial tear substitutes and ointments to lubricate
– Warm compresses and eyelid hygiene
– Prescription anti-inflammatory eye drops
– Plugs for severe dry eye
Other interventions
– Treating underlying infections, allergies, or irritants
– Botulinum toxin injections to reduce tear production
– Surgery for facial paralysis or eyelid problems
Identifying and addressing the specific root cause is important for effectively managing watery eyes long-term. Multimodal approaches combining medication, eye drops, physical therapy, and surgery may be needed in more complex cases.
When to See a Doctor
In most cases, having occasional watery eyes is not a major concern. However, seek medical evaluation if you experience:
– Excessive tearing or epiphora that persists or interferes with vision
– Eye pain, redness, discharge, or irritation along with watering
– New onset of tear production problems
– Watery eyes following injury, new medications, or neurological conditions
– Vision changes, eyelid swelling, or eye appearance changes
Persistent watery eyes can be a sign of underlying eye disorders or health conditions requiring diagnosis and management. Prompt evaluation can prevent complications like infection, scarring, or vision loss.
Some red flags to watch out for include:
| Red Flags | Potential Cause |
| Yellow eye discharge | Bacterial infection |
| Itching or gritty sensation | Allergies, dry eye |
| Watery eyes after face/eye injury | Nerve damage |
| Excessive tearing in infants | Blocked tear ducts |
| Watery eyes with neurological conditions | Nerve dysfunction |
Discuss any bothersome or persistent watery eyes with your optometrist or ophthalmologist, especially if other symptoms are present. They can perform a comprehensive eye exam and determine if any treatment is needed.
Coping with Annoying Watery Eyes
While waiting for an underlying cause of excessive tearing to be treated, these tips may provide some relief:
– Use over-the-counter artificial tear drops to lubricate and rinse the eyes
– Wipe the eyelids and lashes frequently with a clean, warm cloth
– Avoid windy conditions which can exacerbate watering
– Wear sunglasses or goggles when outdoors to protect from irritation
– Adjust computer screen positioning to minimize glare and drying
– Take breaks when reading or doing near-work to rest eyes
– Use a humidifier at home or work to add moisture to dry air
– Limit caffeine intake which may increase tear production
– Apply warm compresses to the eyelids to express clogged oil glands
For chronic or severe cases, your eye doctor may recommend prescription eyedrops, tear duct treatments, or other interventions to address the root problem. Temporary options like moisture chamber goggles or eye patches may also reduce some irritation.
Watery Eyes and MS
For those specifically wondering about watery eyes in the context of multiple sclerosis, here are some points:
– Watery eyes are relatively common in MS, reported in up to 20% of patients
– Inflammation involving the trigeminal or facial nerves is often the cause
– Watery eyes may come and go with MS relapses and remissions
– Other eye issues like dryness, pain, vision changes may also occur
– Medications used for MS treatment can also cause or exacerbate tearing
– Talk to your neurologist about vision changes, they may recommend ophthalmology referral
– Use lubricating eyedrops, avoid irritants, adjust medication timing to manage symptoms
– Address associated dry eye disease through warm compresses, lid hygiene, humidification
– Severe watering may warrant prescription drops or surgical procedures for drainage
– Stay on top of comprehensive eye exams to monitor for complications
While watery eyes associated with MS are not harmful, they can certainly be annoying and disrupt daily activities. Identifying aggravating factors and following eye care tips can help minimize excessive tearing. Work closely with your neuro-ophthalmology team to explore treatment options if the condition is persistent and bothersome.
Conclusion
In summary, watery eyes are a common ocular complaint that can stem from many causes like infection, allergies, dryness, blockages, and neurological dysfunction. MS is one condition that may predispose patients to develop excessive tear production or drainage issues due to nerve inflammation and damage. Although usually not hazardous, chronic watery eyes can impair quality of life and require management. Using lubricating drops, addressing associated dry eye, making medication adjustments, and consulting eye specialists for diagnosis and treatment are some ways those with MS can help control annoying watery eye symptoms. Being attentive to changes and proactive about symptom management can help mitigate the impacts of watery eyes on daily vision function.
