Tearing, increased
Tearing, increased: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
Tears normally bathe the eyes, keeping the epithelium moist and flushing away foreign bodies. Excessive lacrimation (tear production), also known as epiphora, usually results from inadequate tear drainage due to obstruction of the lacrimal drainage system or malposition of the lower lid. Reflex tearing occurs with any disturbance of the corneal epithelium.
Lacrimation may be classified as psychic or neurogenic. Psychic lacrimation normally occurs in response to emotional or physical stress, such as pain, and is the most common cause of increased tearing. Neurogenic lacrimation is triggered by reflex stimulation associated with ocular trauma or inflammation or with exposure to environmental irritants, such as strong light, dry or hot wind, or airborne allergens. This type of lacrimation may also accompany eyestrain, yawning, vomiting, and laughing.
History
If the patient complains of increased tearing, begin by fully exploring this sign. When did it begin? Is it constant or intermittent? Minimal or extensive? Is increased tearing accompanied by pain or irritation? Is there any other drainage or discharge from the eye? Next, ask about recent eye trauma and about ocular and systemic disorders. Then record what drugs the patient is taking. Note his occupation and the nature of his work. For example, does he read extensively, look at a computer screen frequently, or work with small or fine objects. Is he exposed to any chemicals or dust in the workplace?
Physical assessment
After taking vital signs, examine both eyes — unless the history suggests a perforating or penetrating injury. Carefully inspect the external structures. Do the eyelashes contain debris? Examine the eyelids for lesions and edema. Ask the patient to look straight ahead at a fixed object while you check for ptosis. Are the lid margins turned inward or outward? Examine the eyeballs. Do they appear sunken or bulging? Examine the conjunctiva for redness and abnormal drainage. Also, note the color of the sclera. Hold a flashlight at the side of either eye and examine the cornea and iris for scars, irregularities, and foreign bodies. Evaluate extraocular muscle function by testing the six cardinal fields of gaze. Finally, test the patient’s visual acuity.
Medical causes
Conjunctival foreign bodies and abrasions
Increased tearing may accompany localized conjunctival injection, severe eye pain, and photophobia. A foreign-body sensation may be present. Typically, visual acuity isn’t affected.
Conjunctivitis
Typically, increased tearing is accompanied by conjunctival injection and itching. Allergic conjunctivitis also causes a stringy discharge. With bacterial conjunctivitis, other features include copious, purulent discharge; burning; a foreign-body sensation; and possibly eye pain if the cornea is involved. Associated signs of fungal conjunctivitis include lid edema, burning, and a copious, thick, purulent discharge that may form sticky crusts on the lids. The patient complains of photophobia and pain if the cornea is involved. Highly contagious viral conjunctivitis also causes a foreign-body sensation, slight exudate, and lid edema.
Corneal abrasion
Marked by severe corneal pain that’s aggravated by blinking, a corneal abrasion also causes increased tearing. Associated features are a foreign-body sensation, blurred vision, conjunctival injection, and photophobia, which makes opening the lids difficult.
Corneal foreign body
When a foreign body lodges in the cornea, the patient experiences increased tearing, blurred vision, a foreign-body sensation, photophobia, eye pain, miosis, and conjunctival injection. A dark speck may also be visible in the cornea.
Corneal ulcers
With corneal ulcers, a vision-threatening disorder, increased tearing is accompanied by severe photophobia and eye pain. Typically, an early symptom of a corneal ulcer is pain that’s aggravated by blinking. Ulcers also cause blurred vision, conjunctival injection, and a white, opaque cornea. Bacterial ulcers also produce a copious, purulent discharge that may form sticky crusts on the lids.
Dacryocystitis
Increased tearing and a purulent discharge are the chief complaints with dacryocystitis, which is commonly unilateral. Associated signs and symptoms include pain and tenderness around the tear sac with marked eyelid edema and redness near the lacrimal punctum. Pressure on the tear sac expresses a thick, purulent discharge or, in chronic cases, a mucoid discharge.
Dry eye syndrome
Excessive dryness of the cornea and conjunctiva can cause reflex stimulation of the lacrimal gland and excess tearing. Other signs and symptoms include eye pain, conjunctival injection, and itching.
Episcleritis
Commonly unilateral, episcleritis causes increased tearing, photophobia, and — if the sclera is inflamed — eye pain and tenderness on palpation. Inspection reveals conjunctival injection and edema, a purplish pink sclera, and episcleral edema.
Herpes zoster
Increased tearing usually occurs when herpes zoster affects the trigeminal nerve. It’s accompanied by severe unilateral facial and eye pain that’s followed by the eruption of vesicles within several days. The patient’s eyelids are red and swollen with scanty serous discharge. Other common findings include a white, cloudy cornea and conjunctival injection.
Lid contractions
With lid contractions, increased tearing usually results from stricture of the canaliculi. Because lid contractions are caused by burns or chemical or mechanical trauma, lid scars are also commonly visible.
Psoriasis vulgaris
When psoriasis vulgaris lesions affect the eyelids and extend into the conjunctiva, they may cause irritation, increased tearing, and a foreign-body sensation. The lesions are typically preceded by signs of chronic conjunctivitis, such as copious mucoid discharge and conjunctival injection.
Punctum misplacement
Increased tearing is characteristic when ectropion involves the punctum, causing misplacement. It may be accompanied by exposure keratitis.
Thyrotoxicosis
Thyrotoxicosis may cause increased tearing, usually in both eyes. Other ocular effects include ptosis, lid edema, photophobia, a foreign-body sensation, conjunctival injection, chemosis, diplopia and, at times, exophthalmos. Common associated features are heat intolerance, weight loss despite increased appetite, nervousness, sweating, diarrhea, tremors, tachycardia, palpitations, and an enlarged thyroid.
Other causes
Cholinergics
Miotics, such as pilocarpine, may increase tearing.
Special considerations
Obtain a tear specimen for culture. Isolate the patient until a definite diagnosis is made. Also, prepare him for Schirmer’s test to measure tear production and secretion, and for irrigation of the lacrimal drainage system.
Pediatric pointers
The most common pediatric causes of increased tearing include allergies, conjunctivitis, and the common cold.
Patient counseling
Instruct the patient not to touch the unaffected eye to avoid possible cross-contamination. Teach the patient not to share eye makeup or pillowcases and to practice good hand-washing techniques.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
More About Hyper-IgM Syndrome
More Medical Textbooks Online about Hyper-IgM Syndrome
Review other book chapters online related to Hyper-IgM Syndrome:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page:
ALKALOSIS (INCREASED pH) (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
