Excessive, persistent tearing, medically termed epiphora, is a common side effect experienced by many individuals undergoing chemotherapy. This condition involves tears constantly spilling onto the cheek, often causing blurred vision and skin irritation. It is reassuring to know that this symptom is a recognized consequence of certain treatments and that several strategies exist to manage the discomfort. Addressing this issue requires understanding its underlying cause and applying targeted remedies.
The Link Between Chemotherapy and Tearing
Chemotherapy drugs target and destroy rapidly dividing cells, which unfortunately includes the delicate tissues of the tear drainage system. This system channels tears from the eye surface into the nasal cavity, beginning with two small openings called puncta in the inner corners of the eyelids. The medication can cause inflammation and scarring, or stenosis, within the tiny tubes known as the canaliculi that connect the puncta to the tear sac.
When these canaliculi narrow or become blocked, tears cannot drain properly, leading to overflow (epiphora). Chemotherapy agents such as 5-fluorouracil (5-FU) and docetaxel are the most frequently implicated drugs in causing this obstruction. The specific administration schedule can influence the risk; for example, a weekly docetaxel schedule is more likely to cause significant canalicular stenosis than an every-three-weeks schedule.
Practical Steps for Immediate Relief
Managing watery eyes often begins with simple, non-prescription measures focused on reducing inflammation and assisting drainage. Applying a warm compress can be beneficial, as the gentle heat may help loosen minor blockages or thick discharge accumulated in the tear duct openings. Use a clean cloth soaked in warm water, wringing out the excess, and place it over the closed eyelids for five to ten minutes, multiple times a day.
Maintaining excellent eye hygiene is also helpful, as excessive moisture and discharge can lead to secondary skin irritation or infection. Gently clean the eyelids and surrounding skin with a mild, non-irritating cleanser or specific eyelid hygiene solution to remove crusting and prevent chapping. It is important to blot overflowing tears rather than rubbing, which worsens irritation and inflammation around the eye area.
Using preservative-free artificial tears can sometimes provide relief, even though the issue is excessive tearing. These lubricating drops stabilize the ocular surface, which may reduce the reflex tearing triggered by dryness or environmental irritants. Also, manage the immediate environment by avoiding direct exposure to wind, dust, and overly dry air, which stimulate increased tear production.
Specialized Medical Treatments
When self-care measures prove insufficient, an ophthalmologist, often consulting with the oncology team, may recommend specialized interventions. One common procedure for managing early, reversible narrowing of the tear ducts is the placement of punctal plugs. These tiny, biocompatible devices are inserted into the puncta to keep the openings dilated, maintaining an adequate drainage pathway for tears.
For inflammation without scarring, a physician may prescribe topical eye drops containing antibiotics and steroids (e.g., tobramycin and dexamethasone). The steroid component reduces inflammation and swelling in the canaliculi, preventing the progression to permanent scar tissue formation. This early intervention is important for preserving the tear drainage system in patients receiving high-risk chemotherapy regimens.
If the tear duct blockage is severe, permanent, and significantly impacting quality of life, surgical options may be discussed. The most definitive surgical treatment is a dacryocystorhinostomy (DCR). This procedure creates a new drainage pathway between the lacrimal sac and the inside of the nose, and is reserved for cases where the nasolacrimal duct has become irreversibly scarred or obstructed.
When to Seek Professional Help
While mild watery eyes are a manageable side effect, certain symptoms signal the need for prompt medical attention from the oncology team or an ophthalmologist. Any sudden change in vision, including blurriness or a significant decrease in clarity, should be reported immediately. Severe eye pain not relieved by over-the-counter medication is also a serious warning sign requiring urgent evaluation.
The development of thick, yellowish or greenish discharge, accompanied by marked redness or swelling, can indicate an infection like dacryocystitis, which needs immediate antibiotic treatment. Contact a healthcare provider if tearing becomes dramatically worse over a few days, or if symptoms are accompanied by a fever. Open communication ensures that any intervention is safely coordinated with the ongoing cancer treatment plan.