What is the treatment for epiphora (excessive tearing) and ocular pain?

From the Guidelines

For epiphora (excessive tearing) and ocular pain, start with artificial tears like Refresh or Systane, using them 4-6 times daily to lubricate the eye surface and reduce irritation. This approach is based on the most recent evidence from the dry eye syndrome preferred practice pattern 1.

Key Considerations

• Over-the-counter anti-inflammatory eye drops containing ketotifen (Zaditor) or naphazoline/pheniramine (Visine Allergy) can help if allergies are causing symptoms.
• Apply a warm compress for 10 minutes, 3-4 times daily to improve oil gland function and reduce pain, as suggested by the blepharitis preferred practice pattern 1.
• If you wear contact lenses, remove them until symptoms improve.
• For pain, oral acetaminophen or ibuprofen can provide relief.
• If symptoms include redness, discharge, vision changes, or don't improve within 2-3 days, see an eye doctor immediately as these could indicate infection or more serious conditions requiring prescription antibiotics or steroids.
• Avoid rubbing your eyes as this can worsen irritation and potentially cause corneal damage.

Underlying Causes

Underlying causes of epiphora and ocular pain include dry eye syndrome, allergies, infections, or foreign bodies, so proper diagnosis is important for effective long-term treatment. The use of topical cyclosporine 1 or lifitegrast ophthalmic solution 5% 1 may be considered for moderate to severe dry eye syndrome.

Additional Treatments

Additional treatments such as punctal occlusion, tarsorrhaphy, or autologous serum eye drops may be considered for severe dry eye syndrome, as discussed in the dry eye syndrome preferred practice pattern 1. However, these treatments should be guided by an eye care professional.

Important Considerations

It's essential to note that while these treatments can provide relief, proper diagnosis and management of the underlying cause are crucial for effective long-term treatment. The evidence from the most recent studies 1 supports a stepwise approach to managing epiphora and ocular pain, starting with artificial tears and warm compresses, and progressing to more advanced treatments as needed.

From the FDA Drug Label

Directions Adults and children 3 years of age and older: Put 1 drop in the affected eye(s) twice daily, every 8-12 hours, no more than twice per day. Children under 3 years of age: Consult a doctor. The treatment for epiphora (excessive tearing) and ocular pain is not explicitly stated in the provided drug label for ketotifen (OPHTH) 2.

From the Research

Treatment for Epiphora (Excessive Tearing) and Ocular Pain

• The treatment for epiphora and ocular pain can vary depending on the underlying cause, but some studies suggest that ketotifen fumarate eye drops can be effective in reducing symptoms of allergic conjunctivitis, which can include excessive tearing and ocular pain 3, 4, 5.
• In a study published in 2003, ketotifen fumarate 0.025% ophthalmic solution was found to be effective in reducing the signs and symptoms of seasonal allergic conjunctivitis, including ocular itching, redness, and tearing 3.
• Another study published in 2004 found that ketotifen fumarate 0.05% eye drops were effective in treating seasonal allergic conjunctivitis, with subjective symptoms disappearing in 60-80% of patients after 10 days of treatment 4.
• However, a study published in 2020 found that patients with dry eye disease and severe ocular pain were less responsive to treatment with artificial tears, lubricating ointment, and other therapies, highlighting the need for further investigation into effective treatments for ocular pain 6.
• A study published in 2023 discussed the diagnostic and therapeutic considerations for watery eyes, including the importance of distinguishing between increased tear production and impaired tear drainage 7.

Treatment Options

• Ketotifen fumarate eye drops: effective in reducing symptoms of allergic conjunctivitis, including excessive tearing and ocular pain 3, 4, 5.
• Artificial tears: may be less effective in patients with severe ocular pain 6.
• Lubricating ointment: may be less effective in patients with severe ocular pain 6.
• Steroid eye drops: may be less effective in patients with severe ocular pain 6.
• Cyclosporine 0.05%: may be less effective in patients with severe ocular pain 6.
• Autologous serum tears: may be less effective in patients with severe ocular pain 6.
• Hot compresses: may be less effective in patients with severe ocular pain 6.
• Lid hygiene: may be less effective in patients with severe ocular pain 6.
• Punctal occlusion: may be less effective in patients with severe ocular pain 6.