Involuntary Eye Watering During Micturition: A Case Report and Literature Review

Literature review

There are 5 case reports in the literature with similar findings. The main findings from their reports are summarised in Table 1. Due to the apparent rarity of this phenomenon, there is uncertainty in regard to the prevalence. However, there is a possibility that it is underreported due to its relatively benign nature and possible embarrassment associated with presenting to a medical professional. The first reported case was in 1932; however, the epiphora was more significant during defecation than urination, which was not found in our case or any of the other case reports [1].

In 2 cases, the phenomenon was associated with other symptoms, such as facial redness and warmth [2] or a vacant appearance and jaw dropping [3]. Our patient did not experience any other symptoms.

In all cases, the epiphora had existed from childhood, and examination revealed no other abnormality. No other case report reported any past medical conditions, including ours. Interestingly, 5 out of 6 cases (including ours) are female, although the current significance of this is unclear.

Treatment has been attempted in 3 cases. In 2, the epiphora was eliminated completely with an intravenous injection of atropine just before urination [1,4]. In one of these cases, a bladder control regime of frequent voiding without the urge of micturition reduced the eye watering in a 5-year-old but did not eliminate it [4]. In 1 further case, a regime of bladder retraining consisting of 2-hour timed voiding, double voiding, and an increase in fluid intake, as well as bowel management with laxatives, markedly improved the watery eye in a 4-year-old [2].

Within this limited dataset, the clear trends that are elucidated are a female preponderance and an onset at a very early age. In all cases, the patients were otherwise healthy, and there was no associated pain, discomfort, or anatomical ocular or genitourinary abnormality. No cases reported a positive family history. In the cases where treatment targeting the parasympathetic nervous system was trialled (atropine and bladder retraining), there was an improvement in symptoms. There is variability in the presence or absence of associated symptoms.

Lacrimation and urination are controlled by the parasympathetic nervous system; a common pathway developing aberrantly in utero may explain this observation. This theory is supported by the marked elimination in response to antimuscarinic treatment. The reduction in symptoms secondary to bladder retraining also suggests an action via reduction of parasympathetic stimulation of the bladder.

Whether active management is necessary will depend heavily on patient preference and any associated distress. Considering the benign nature of this condition, ongoing treatment with atropine would not be justified due to the risk of antimuscarinic side effects. Bladder retraining may be a more acceptable option in patients who are of sufficient age to comply.

The limitations of this report include the limited sample size, lack of long-term follow-up, and the absence of investigations such as atropine testing.

In conclusion, we present the case of an 11-year-old female presenting with painless bilateral tearing during urination with a normal ocular and urinary system examination. In the context of the growing number of reports on this condition, we question whether this phenomenon is underreported.