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Epiphora

A watering eye is when tears flow out of the eye and roll down the cheek.

A watering eye (epiphora) is when tears flow out of the eye and roll down the cheek.

It usually happens if your tears don't drain away properly or too many tears are produced.

These problems can occur as a result of conditions such as conjunctivitis (eye inflammation), problems with your eyelids, an eye injury, a blocked tear duct or something irritating your eye, such as car fumes.

Read more about what causes watering eyes.

How tears work

Tears are constantly produced to keep the eyes moist. They are produced in small glands (lacrimal glands) located underneath your upper eyelids.

When you blink, tears are spread over the front of your eyes. The tears then pass into tiny channels known as canaliculi, before draining into a tear "sac" and flowing down the tear duct into your nose.

Watering eyes are the result of problems with this process.

When to see your GP

You should see your GP if you have persistent watering eyes, or any lumps or swelling around your eyes.

Who is affected?

You can get watering eyes at any age but it is most common in young babies (0-12 months) and people over the age of 60. It can affect one or both eyes and can cause blurred vision, sore eyelids and sticky eyes. 

How are watering eyes treated?

You should make an appointment to see a GP if you are concerned by persistently watering eyes.

Watering eyes do not always need to be treated. Treatment will depend on how severe the problem is and what is causing it.

If watering eyes aren't interfering with your life, you may choose not to have treatment.

In cases where irritation is causing the eye to water, treatment involves removing the source irritation. For example, if an eyelash is growing into your eye, it can be removed.

If a watering eye is caused by a blocked tear duct, surgery may be needed to clear the blockage or create an alternative way for tears to drain away.

Read more about diagnosing watering eyes and treating watering eyes

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Epiphora

Watering eyes usually occur if too many tears are produced or if they cannot drain away properly.

Watering eyes usually occur if too many tears are produced or if they cannot drain away properly.

Blocked tear ducts

Tear ducts are the tubes through which excess tears drain away. If they become blocked, it can cause your eyes to water.

In adults, this is usually the result of age, or sometimes inflammation, compression or trauma.

If your tear ducts are blocked or narrowed, your tears will be unable to drain away and will remain in the tear sac. If this happens, the tears in the tear sac may become stagnant and a sticky liquid (mucus) may discharge through the tear duct opening into the eye.

You may also develop a swelling on the side of your nose, next to your eye, which is called a mucocoele. If this becomes infected, it can cause a painful abscess to develop just below your eye which may need to be treated with antibiotics and possibly surgery.

Occasionally, the canaliculi (the narrow drainage channels on the inside of your eyes that lead into the tear ducts) can become blocked. This can be caused by inflammation or scarring due to a viral infection, or other damage, such as trauma. 

In addition, the lower eyelid can sometimes turn out (ectropion), causing the openings to the tear ducts to move away from the eye and making it difficult for the tears to reach them.  

Blocked tear ducts in babies

Babies are sometimes born with under-developed tear ducts. The tear ducts can be completely or partially closed (congenital nasolacrimal duct obstruction) and can cause the baby’s eyes to water. Most blocked tear ducts in babies get better on their own before the baby is one year old.

In some cases, babies with a blocked tear duct can develop eye infections (conjunctivitis). Their eye may be red and have a sticky discharge coming from it. Take your baby to see your GP if you think they might have an eye infection.

If your baby's eyes are still watering after the age of one, they may need a small procedure called "probing" to unblock the tear duct. Only a very small number of babies with watering eyes require this type of treatment. See treating watering eyes for more information about probing.

Poor tear pump

In addition to needing unblocked tear ducts, a good blink is required to ensure tears drain properly into the tear duct. People with a weak blink, for example due to a condition called Bell’s palsy (a type of facial paralysis) have problems with this which contributes to their watery eyes.

Excess tears

There are several reasons why you might produce excess tears, some of which are outlined below.

Irritation

Excessive tear production (reflex tearing) is usually the result of eye irritation. Extra tears are produced to wash away the substance irritating your eye (irritant).

Problems that can cause extra tears to be produced include:

  • chemical irritants, such as onions or fumes
  • an eye infection, such as conjunctivitis
  • an allergy
  • an eye injury, such as a piece of grit that becomes lodged in the eye
  • an inward-turning eyelid (entropion) - see eyelid problems for more information
  • an outward-turning eyelid (ectropion)

Abnormal tears

Tears are made up of different substances including water, proteins and oils. If your tears have an abnormal oil content, they may not be able to spread evenly across your eye. This can result in dry patches developing on your eyes which become sore and cause extra tears to be produced.

If you have abnormal tears and dry patches, you may have dry eye syndrome, which can cause your eyes to become red, feel gritty and sometimes water excessively due to reflex tearing.

Blepharitis

Blepharitis is a condition where the rims of your eyelids become inflamed, resulting in your eyes stinging or itching. This irritation can cause reflex tearing. It can also affect how your tears are spread across the surface of your eyes. If your tears are not spread out properly, this can also cause your eyes to water, as described above.

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Epiphora

Your GP may refer you to an ophthalmologist for an examination if no obvious reason for your watering eye can be found.

Your GP may refer you to an ophthalmologist for an examination if no obvious reason for your watering eye can be found.

An ophthalmologist is an eye care specialist. They can use special equipment to look for the cause of your watering eye.

This specialist examination may not be necessary if it is thought that your watering eye is related to a previously diagnosed eye condition, such as conjunctivitis or an inward-growing eyelash.

Referral to an ophthalmologist

An ophthalmologist will look for blockages in your tear ducts, using local anaesthetic eye drops to help reduce any discomfort.

A probe may be inserted through narrow points on the inside corner of your eyelids (puncta) and into the narrow drainage channels on the inside of your eyelid (canaliculi) to determine whether they are blocked. Fluid may also be injected down into your tear duct to see whether it comes out normally.

Another test involves placing a drop of a special dye in each eye. If there is a significant amount left in your eyes after five minutes of normal blinking, your tear ducts may be blocked.

Sometimes scans of your tear ducts may be carried out. These can involve either injecting or placing special dyes into the tear ducts and then taking X-rays or other scans to help pinpoint the location of the blockage.

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Epiphora

Treatment for watering eyes is not always necessary. Having treatment will depend on how severe the problem is and what is causing it.

Treatment for watering eyes is not always necessary. Having treatment will depend on how severe the problem is and what is causing it.

Treating irritation

If irritation is causing your eye to water, treatment will usually focus on removing the source of irritation.

If an infection, such as conjunctivitis, is causing watering eyes, your GP may treat you with a course of antibiotics if they feel that the infection is due to a bacteria. If they suspect the condition is due to a virus, you may be advised  to wait for a week or so to see if the condition resolves itself.

If your eyes are watering due to an allergy, a type of medication called an antihistamine may be prescribed to help reduce the inflammation.

In cases where irritation is caused by an inward-growing eyelash or a foreign object, such as a piece of grit, these can be removed.

If your lower eyelid turns inwards (entropion) or outwards (ectropion), a minor operation carried out under local anaesthetic may be recommended. The most common procedure involves tightening the tendon that holds the outer eyelid in place to give it extra support. See treating ectropion for more information.

Surgery for blocked tear ducts

Tear ducts are the tubes through which excess tears drain away. If a blocked tear duct is causing watering eyes, it can be treated with surgery.

However, it is up to you whether or not you want treatment. If your watering eye is not bothering you, surgery may not be necessary.

If your eye is sticky or if there is a lump below your eye, treatment is usually recommended to avoid your eye from becoming infected. If your symptoms are particularly severe and your watering eyes are interfering with your vision for driving, reading and sports, treatment may be appropriate.

If you have an infection in your tear sac (where excess tears from your eyes drain into), it will need to be treated with antibiotics and then most likely with surgery. Left untreated, the infection could spread to your eye socket.

Dacryocystorhinostomy (DCR)

Dacryocystorhinostomy (DCR) is a common surgical procedure used to treat blocked tear ducts. It involves creating a new channel from the tear sac to the inside of your nose. This channel allows tears to bypass the blocked part of your tear duct.

Before having surgery, your nose may be examined to check the nasal space and that the lining of the nose is healthy. 

In general, the surgery involves removing a very small piece of bone from the side of your nose, allowing the tear sac to drain directly into the nasal cavity. This can be done externally (by making a small incision in the skin on the side of your nose) or endoscopically (from inside the nose, using an endoscope). An endoscope is a narrow, flexible tube with a light at the end). The bone can be removed surgically or by using a laser.

A very thin silicone tube is usually inserted to keep the channel open. After a couple of months, the tube will be removed and the channel should stay open without it.

The DCR procedure is usually carried out under general anaesthetic and takes up to an hour to perform.

If the tear duct is not blocked but just narrowed, a thin tube with a small balloon at the end (a balloon catheter) can sometimes be used to widen it.

After surgery

Most DCR surgery is carried out as a day case procedure, which means you can go home the same day. You will be given instructions to follow when you are discharged – for example not to blow your nose for 2 weeks after surgery. You may also be given some eye drops or ointment to use to prevent infection and inflammation, as well as a nasal spray.

There could be some bruising and swelling around your nose and eye, which should improve over a few days or weeks. You may also experience nosebleeds for a few days. However, these are usually minor and should stop in due course.

Blocked canaliculi

If the drainage channels on the inside of your eye (canaliculi) are completely blocked by tears, an operation to drain them may be required, usually involving a small glass tube (called a Lester Jones Tube) being inserted to bypass the blockage and drain the tears.

Treating watering eyes in babies

In babies, watering eyes often improve without the need for treatment by the time the baby is a year old.

Massaging the tear ducts may help to dislodge tears that have collected in the upper part of your baby’s tear duct, as well as encouraging the tear duct to develop. This can be done by applying light pressure with your first (index) finger and massaging from the corner of your baby’s eye towards their nose. Repeat the massage several times a day for a couple of months. Before massaging, wash your hands. 

You can also soak a cloth with warm water and hold it against your baby’s eye. This may encourage the tears to drain. If your baby has an eye infection (conjunctivitis), this may need to be treated with antibiotic eye drops. 

Probing

In 9 out of 10 cases, the tear duct opens by itself before your baby is one year old. However, if your child is over a year old or has repeated infections caused by the blocked tear duct, a procedure may be used to open their tear duct using a probe. This will be carried out under general anaesthetic.

Very occasionally a dacryocystorhinostomy (DCR) operation is required (see above).

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