Sore watery eyes
Most common reason for eye discomfort
As we age our tears change to become less well balanced and healthy. Tears no longer cover the front of the eye (the cornea) to give total comfort. We need a good tear film to keep our eyes comfortable and our vision clear. When anything irritates our eyes we feel discomfort, itching or pricking, and we make more tears causing our eyes to water – think onions, dust in our eyes or smoke, for example.
At around 40 years of age, we can begin to get regular symptoms of eye irritation with sudden reflex watering. This irritation is due to dry spots appearing on the cornea as the tear film becomes increasingly unstable.
The tear film is made up of three layers
The thin mucous layer coats the cornea, allowing a thicker second watery layer to coat the eye. The third outer part is the oil layer, made by the eyelid meibomium gland. This outer oil layer, when intact, coats the watery layer to stop evaporation and give a stable tear film.
The eye is covered in this three-layer tear film, but small patches can dry out when it is unstable, no longer forming a continuous layer over the cornea. As the cornea is the most sensitive part of the body, even a microscopic dry patch (less than 1mm) is felt as irritation, pain or can even give the sensation of being poked in the eye. Sometimes it can even feel needle sharp with sudden intense pain, yet, importantly, no damage is occurring. As soon as you blink or close your eye, tears again cover the dry area of the cornea and the sensation goes away.
As a result of the sensitivity and feeling of irritation or pain, our eyes make more tears and water. Even microscopic dry patches on the cornea cause watery eyes. It is the instability of the tear film that causes the dry patches and watering.
Most people have unstable tear film and watering, rather than dry eyes. Artificial tears are to cover the eye and make the tear film more stable. You may be advised to take more artificial tears for what you thought was a watery eye. True dry eye is when very few or no tears are being made. People with inflammatory arthritis can suffer from true dry eye, producing few or no watery tears.
A simple test to try
Close your eyes and wait a few seconds. Now open your eyes and stare for 20 seconds if you can. Does this reproduce all of your symptoms? If so, then you have proven to yourself you very likely have an unstable tear film.
The good news is this is most likely not going to cause permanent damage to your eye or vision. Symptoms are recurrent and chronic but not damaging. You can try various artificial tears that may help.
The more viscous the artificial tear, the longer it lasts, although it may cause a little blur at first. More watery artificial tears have less effect. Artificial tears with benzalkonium chloride preservative can worsen your symptoms and damage the surface cells of the cornea. If you feel you want to use regular artificial tears then try a tear drop with no preservatives or one with special preservatives that do not cause corneal surface damage.
