Many people experience watery eyes, which can be irritating and can interfere with vision. While it may seem counterintuitive, watery eyes may be a sign of dry eye disease. In most cases, watery and runny eyes indicate an underlying condition called Meibomian Gland Dysfunction, which plays a major role in dry eye symptoms. Meibomian Gland Dysfunction, also called MGD, affects the production of the natural tear film of the eye and can result in symptoms such as watering, burning, grittiness, or feeling like something is “in the eye.” In order to stop these symptoms, we have to address the underlying dryness.
What is Meibomian Gland Dysfunction?
Millions of small glands called Meibomian glands are located along the eyelids. These glands are essential for producing the outermost layer of the tear film, called “meibum.” Meibum is an oily substance that keeps that tear film stable and prevents it from evaporating, so the tears are able to stay on the front surface of the eye for a longer time and provide more nourishment and protection. In cases of MGD, the Meibomian glands do not produce an adequate amount of meibum because they are blocked, clogged, or malfunctioning in some other way. When the tear film is missing this important lipid layer, the tears will evaporate quickly, leaving the front surface of the eye exposed. When this occurs, the eye begins to feel very dry and irritated, which causes the production of reflex tears in an attempt to re-nourish the eye. Unfortunately, these reflex tears are the “wrong type” of tear, meaning they are poor quality and unable to properly lubricate the eye. Instead, they tend to evaporate immediately, or quickly roll off the front surface of the eye onto the eyelids or cheeks. Thus, when your eyes are watering, it can actually be a sign of dry eye disease and underlying problems with your Meibomian glands.
Treating Watery Eyes
In order to prevent your eyes from watering, you must treat the underlying MGD. Like dry eye disease, addressing Meibomian gland dysfunction requires long-term treatment with the goal of improving health of the eyelids and ocular surface. Common treatment options for MGD include warm compresses and lid scrubs. Warm compresses include holding a heated washcloth or commercially prepared mask against the eyelids for 10-15 minutes, done once or twice a day. The heat from these compresses helps unclog or unblock Meibomian glands and promotes the release of meibum into the tear film. Lid scrubs also reduce the number of blocked or clogged Meibomian glands by effectively removing oils, makeup, or other debris along the base of the eyelashes. Lid scrubs should be done nightly by using warm water and a soft soap, or a commercially prepared lid wipe, and scrubbing the base of the eyelashes for roughly thirty seconds. If warm compresses and lid scrubs are not effective enough in treating your MGD, your doctor may consider other options. A short course of antibiotics can be considered if there is a bacterial or inflammatory cause to your MGD. Additionally, your doctor may perform some form of in-office gland expression, where they physically press on the Meibomian glands to force the meibum back into the tears.
The treatment for Meibomian Gland Dysfunction and dry eye disease is chronic and long-term, so work with your optometrist to ensure your treatment approach is effective in treating your symptoms.