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Ask Dr. Rick Your Own Question
Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 10771
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Every time I smile or just regularly laugh my eyes water and

Customer Question

Every time I smile or just regularly laugh my eyes water and everyone thinks I'm getting emotional. Its an everyday all day type of thing. It really bothers me.
JA: When was the last time you had your eyes checked? In general, how has your vision been lately?
Customer: It's been years. But I feel like my vision is very good. No blurryness or anything.
JA: Anything else in your medical history you think the doctor should know?
Customer: Not really much medical history just. Been reguarly
Submitted: 19 days ago.
Category: Eye
Expert:  Dr. Rick replied 19 days ago.

Hi. I'm Dr. Rick and I have two decades of ophthalmology and retina surgery experience. I'm online and happy to answer your question today.

Expert:  Dr. Rick replied 19 days ago.

How old are you?

M/F?

Do you wear contacts?

Do your eyes water at any other times?

How long has this been going on?

Can you upload a picture of your eyes/eyelids?

Do you have any other medical problems or take any medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.

Customer: replied 19 days ago.
25 female
No contacts
Yes all through out the day but more severe when laughing and smiling. They feel slightly dry and,burning when it happens
For about 8 years
No,medicines.
Expert:  Dr. Rick replied 19 days ago.

have you had any facial trauma?

Customer: replied 19 days ago.
None at all
Expert:  Dr. Rick replied 19 days ago.

Thank you for that additional information.

You might have some sort of aberrant nerve connections.....although this would be very rare without some sort of past surgery or trauma.

I'm not sure if this will work, but you might try some home treatment for blephartitis and see if things get better.

If they don't then you are probably going to have to be evaluated at a large medical center like the Mayo clinic for rare conditions.

Give this a try for a month (ignore all the stuff about having this and that and just pay attention to the home treatment):

It sounds like you are suffering from an anterior segment/tear film issue. Many times, for all sorts of reasons, the anterior surface of the eye starts to have difficulties. What can cause this? Well, there are a number of conditions but the most common are dry eyes, allergies and blepharitis....many times all three conditions act together to make you miserable. In order to solve your problem you need to address all of these issues at the same time.

When it comes to allergies it is almost impossible to pin down the offending agent(s) and, therefore, treatment needs to focus on controlling the symptoms. Dry eyes are very common and can be improved by a stepwise series of therapies. First, the use of natural tears 4-6+ times/day to augment your natural tear production and the use of a medication called restasis to improve your tear production, if this doesn’t work then you can try temporary punctal occlusion of the lower puncta, then, if needed, temporary occlusion of all 4 puncta then, if indicated, surgical ( non-reversible) closure of the puncta. The openings to your tear drainage system are called puncta and you have one opening on each lid, near your nose. If this does not give relief then your eyelid opening can be made smaller with surgery (lateral Tarsorrhaphy).

Blepharitis is a condition where glands in the eyelids are not functioning normally. They become plugged and instead of putting out their normal clear, oily secretions, they put out thick, toothpaste like gunk. You may not be able to see this “gunk” yourself, unless it is really bad, but it shows up clearly on slit lamp examination.

The best treatment for this condition is daily lid scrubs combined with warm compresses. I like to use baby shampoo for lid scrubs. In the shower, place the shampoo on your index fingers, close your eyes, raise your eyebrows (to stretch the skin on your eyelids) and scrub back and forth along your eyelashes for 3 to 5 minutes. The hot water in the shower helps to soften the plugged oils in the glands while the mechanical scrubbing with your soapy fingers removes the oils.

Baby shampoo lid scrubs will also help to wash away allergens and stimulate tear production, thereby addressing all three of your issues. Remember, this is not an instant fix. While you are waiting for the lid scrubs to have affect you can use over the counter allergy pills such as Travist, dimetapp or Zyrtec.

Should your symptoms get worse, your vision become significantly affected or things just not get better in 3 weeks or so you should have a complete eye examination by your local ophthalmologist to look for other, less common, causes of your symptoms.

I understand that this treatment seems a bit "too low tech" to be of value, but after 2 decades of clinical practice, I can assure you (even from personal experience :) that it does, indeed, work.

Does this make sense to you?

Don't forget to mash the positive feedback button for me...the one labeled "excellent" is the most fun to push by far ;)

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick MD FACS

As you might imagine your symptoms are not at all common. If the lid scrubs etc help, then all well and good.

If not.....time for a extensive ophthalmology, orbital and innervation workup of your entire lacrimal, sinus and nasal system