By Nicholas Robert Galloway MD, FRCS, FRCOphth, Winfried Mawutor Kwaku Amoaku FRCS, FRCOphth, PhD (auth.)

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It may be the golfer whose glasses keep misting up on the fairway or the housewife who is embarrassed by tears dropping on food when cooking, or it may be the six-rnonth-old baby whose eyes have watered and discharged since birth. Sometimes an elderly patient may complain of watering eyes when on examination there is no evidence of tear excess but the vision has been made blurred by cataracts. Some degree of tear overflow is of course quite normal in windy weather, and the anxious patient may over-emphasise this; it is important to assess the actual amount of overflow by asking the patient whether it occurs all the time both in and out of doors.

This in turn is due to slackening of the fascial attachments of the lower margin of the tarsal plate. At first the eyelid turns in whenever the patient screws up the eyes but eventually the lid becomes permanently turned in so that the lashes are no longer visible externally and rub on the cornea. Such patients complain of watering sore eyes and the matter can be corrected very effectively by eyelid surgery. Entropion may also result from scarring and contracture of the conjunctiva on the inner surface of the eyelid.

It is important to have some understanding of the anatomy of th e cornea if one is attempting to remove a corneal foreign body. One mu st realise, for example, that the surface epithelium can be stripped off from the underlying layer and can regrow and fi11 raw areas with extreme rapidity. Under suitable conditions the whole surface epithelium can reform in about 48 h. The layer underlying or posterior to the surface epithelium is known as Bowman's mern brane and if this layer is damaged by the injury or cut into unnecessarily by over-zealous use of surgical instruments, then a permanent scar may be left in the cornea.

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