Excessive watering can cause a feeling watery eyes or Direction is the result that the tears on the cheek overflow (epiphora). Pathophysiology tears are produced in the lacrimal gland and draining through the upper and lower puncta into the canaliculi and then into the lacrimal sac and the nasolacrimal duct (anatomy of the lacrimal system.). An obstruction of the tear ducts can lead to stasis and infection. Recurrent infections of the lacrimal sac (dacryocystitis) can sometimes spread, potentially leading to an orbital cellulitis. Anatomy of the lacrimal system. Etiology In general, the most common causes of tear flow infections of the upper respiratory tract allergic rhinitis tears flow can be caused by increased tear production or decreased nasolacrimal drainage. Increased lacrimation The most common causes are infections of the upper respiratory tract Allergic rhinitis Allergic Conjunctivitis Dry eyes (reflex tears that are produced in response to dryness of the eye surface) trichiasis Any disorder that causes irritation of the conjunctiva or the cornea, can increase the flow of tears (s. some causes of tear flow). However, most patients present with corneal diseases, the excess lacrimation cause (z. B. corneal erosion, corneal ulcer, corneal foreign bodies, keratitis) or with acute angle-closure glaucoma or anterior uveitis with other eye symptoms as lacrimation moment (z. B. eye pain, redness). Most people who have been crying, will not intervene to assess the flow of tears to lassen.Verminderte nasolacrimal drainage The most common causes are idiopathic age-related stenosis of the nasolacrimal duct Dakryozystitis ectropium An obstruction of the nasolacrimal lacrimal system can be caused by strictures, tumors or foreign bodies (eg . as stones, often associated with subclinical infection by Actinomyces). The obstruction can also be a congenital malformation. Many medical conditions and medications can cause a stricture or obstruction of nasolacrimal tear ducts. Some causes of tear flow cause suspicious findings interference that may cause an excess tear production Dry eyes with reflex tears on cold or windy days or when exposed to cigarette smoke or dry heat worse Intermittent foreign body sensation (In patients with a disorder that is known to cause dry eyes z. B. blepharitis) irritation of the ocular surface (for. example, allergic conjunctivitis, corneal abrasion or erosion or -ulkus, foreign bodies , Hordeolum, infective conjunctivitis, irritating chemicals, keratitis, trichiasis, challenge with dotted lesions due to a paresis of Blinzelmuskeln like a facial nerve palsy) grittiness redness in patients with Kornealäsionen, pain, constant foreign body sensation and photophobia allergic conjunctivitis itching may follicles on tarsal conjunctiva Nasal irritation (z and inflammation. As allergic rhinitis, infection of the upper respiratory tract) runny nose, sneezing, nasal congestion problems, the obstruction of the nasolacrimal tear ducts cause congenital nasolacrimal duct obstruction symptoms that begin shortly after 2 weeks of age Idiopathic age-related stenosis of the nasolacrimal duct Usually normal investigation except for evidence of obstruction Dakryozystitis Nasal pain often swelling, redness and warmth over the lacrimal sac and sensitivity to pain and pus on palpation tumors hard mass in the system of the nasolacrimal duct, particularly in the elderly Other causes of stricture or obstruction of nasolacrimal tear ducts (see text) Often risk factors often no characteristic examination findings other than the obstruction diseases involving reduced runoff without obstruction cause misalignment between the tear film and the punctum (eg. B. Ectropion, Entropion) usually comprise visible when examined Other causes of stricture or obstruction of nasolacrimal lacrimal burns chemotherapeutics eye drops (particularly Ecothiophatiodid, epinephrine and pilocarpine) infection, including canaliculitis (z. B. caused by Staphylococcus aureus, Actinomyces, Streptococcus, Pseudomonas , herpes zoster virus, herpes simplex conjunctivitis, infectious mononucleosis, human papilloma virus, Ascaris, leprosy and tuberculosis) Inflammatory diseases (sarcoidosis, granulomatosis with polyangiitis [previously known as Wegener’s granulomatosis]) injuries (eg nasoethmoidale fractures;. nasal , orbital or endoscopic sinus surgery) obstruction de s nose output despite an intact nasolacrimal system (eg. B. infection of the upper respiratory system, allergic rhinitis, sinusitis) radiation therapy, Stevens-Johnson syndrome, tumors (eg., Primary tumors of the lacrimal sac, benign papilloma, squamous and basal cell carcinoma, transitional cell, fibrous histiocytoma, midline granuloma, lymphoma) evaluation history questions for the current disease deal with the duration, the beginning and the severity of the symptoms, including the question of whether tears on the cheek drops (real epiphora). The effects of weather, ambient humidity and cigarette smoke are determined. The evaluation of symptoms should for symptoms of possible causes were looking for, such as itching, runny nose or sneezing, especially when it occurs constantly or after exposure to specific, potential allergens (allergic reaction), eye irritation or pain (blepharitis, corneal erosion, irritating chemicals) and pain near the medial canthus (dacryocystitis). Other symptoms are less reliable, but should be recorded yet; they include positional headache, purulent rhinitis, nocturnal cough and fever (sinusitis, granulomatosis with polyangiitis), rash (Stevens-Johnson syndrome), cough, shortness of breath and chest pain (sarcoidosis) and epistaxis, hemoptysis, polyarthralgia and muscle pain (granulomatosis with polyangiitis). The history should inquire known disorders that can cause tearing, including granulomatosis with polyangiitis, sarcoidosis and is being treated with chemotherapy cancer, disorders that cause dry eyes (eg., Rheumatoid arthritis, sarcoidosis, Sjogren’s syndrome) and drugs such as echothiophate, epinephrine and pilocarpine. The ocular and nasal history is determined, including infection, injury, surgery and Strahlenbelastung.Körperliche examination The physical examination focuses on the eye and surrounding structures. The face is controlled; asymmetry suggests a congenital or acquired nasolacrimal duct obstruction out. When a slit lamp is available it should be used to examine the eyes. The conjunctiva and corneas are to lesions, including punctate spots and redness investigated. The cornea is stained with fluorescein and examined. The lids are everted to detect hidden debris. The lids, including the puncta are inspected closely for foreign objects, blepharitis, hordeola, ectropion, entropion and trichiasis. The lacrimal sac (near the medial canthus) is palpated to hyperthermia, pain, tenderness and swelling. This swelling can be palpated in terms of their consistency and to see if pus comes out. The nose is not clogged, pus and bleeding untersucht.Warnzeichen The following findings are of particular importance: Repeated, unexplained episodes of tearing Hard mass in or near the structures of the nasolacrimal lacrimal interpretation of results results in an obstruction of the nasolacrimal lacrimal suggest include tears on the cheeks crowded (true epiphora) Lack of signs of a specific cause of a cause is often seen in the clinical evaluation (see table: Some causes of tear flow) .Tests tests are often unnecessary, because the cause is usually It can be seen from the study. A Schirmer test with a large amount of wetting agent (eg. As> 25 mm) indicates evaporative dry eye as etiology of tears flow. A Schirmer test with very little wetting (<5.5 mm) indicates dry eyes due to a tear deficiency. Typically, the Schirmer test is carried out by an ophthalmologist that it will be correctly performed and interpreted to ensure. A probing and irrigation of lacrimal tear duct system can help uncover an anatomical obstruction of the tear ducts and a stenosis due to full Obstrutkion the nasolacrimal lacrimal system. A purge is performed with and without fluorescein Ffarbstoff. A reflux through the other punctum or the other canaliculus signaled a firmly established obstruction, while a reflux points with drain through the nose to a stenosis. This test has only supporting character and is performed by ophthalmologists. Imaging techniques (such Dakryozystographie, computed tomography, nasal endoscopy) are sometimes useful for illustrating the abnormal anatomical conditions, when surgery is planned, or may occasionally demonstrate an abscess. Therapy The underlying disorders (eg. As allergies, foreign bodies, conjunctivitis) to be treated. If dry eyes or Hornhautepitheldefekte are the cause, the epiphora reduced by the use of artificial tears. A congenital nasolacrimal duct obstruction often improves spontaneously. Before the first year of life the manual compression of the lacrimal sac may lead to the opening of the closure (4 to 5 times a day). After the first year of life of the nasolacrimal duct may need to be probed under general anesthesia. If the obstruction is recurrent, a temporary drainage may be used. With an acquired nasolacrimal duct closure flushing of the nasolacrimal duct may be sufficient as a therapy if the underlying condition does not respond to treatment. As a last resort can surgically a connection between the lacrimal sac and the nasal cavity to be created (dacryocystorhinostomy). In the case of Tränenpünktchen- or Kanalikulusstenose dilation usually leads to healing. But with a pronounced and disturbing Kanalikulusstenose, surgery may be considered in which a glass tube that extends from the Caruncle up into the nasal cavity, is used. Basics of Geriatrics An age-related idiopathic nasolacrimal is the most common cause of unexplained Epiphora in the elderly, but the presence of tumors should also be considered. SUMMARY If tears do not overflow on the cheek, dry eyes are often the cause. When tears overflow on the cheek, obstruction of the nasolacrimal tear duct is likely. Tests are often unnecessary, but in cases of recurrent infectious dacryocystitis which can develop into more serious conditions such as Orbitaphlegmonen needed.