Watering eyes are a common problem, generally affecting babies and older people. A blocked tear duct is the most common cause but there are a number of other causes. You may not need treatment if symptoms are mild. An operation can usually cure a blocked tear duct. Other treatments depend on the cause.
Causes of watering eyes
Overactive tear ducts
Anything that irritates the eye can cause you to produce excess tears. The watering is a protective reflex to help clear irritants away from the eye. For example:
- Chemical irritants such as onions or fumes from machines.
- Eye infection in the front of the eye (infection conjunctivitis).
- Allergy causing inflammation of the front of the eye (allergic conjunctivitis).
- A small injury or scratch to the front of the eye, or a piece of dirt or grit which gets stuck in the eye.
- Dry eye syndrome.
Blocked drainage of tears
- This is pretty common in babies: their tear ducts tend to be a bit narrow and can't handle all their tears (and babies do cry a lot). Babies' tears are quite thick and if they're blocked, they get a bit gunky. That's why a lot of babies have gunky eyes, even though there's no infection. It usually clears by itself in a few months, or certainly by the age of 1 year. All you need to do is wipe away the gunk with a clean cotton wool pad and warm water. See the separate leaflet called Tear Duct Blockage in Babies for more information about this.
- In elderly people their tear ducts often get narrower with age. So the tears can't drain away properly, making their eyes very watery. Occasionally the blocked tear duct gets a mild infection and makes the skin just between the nose and eye red and sore.
Problems with eyelashes or eyelids
- In the elderly the eyelashes can turn inwards, scratching the eyeball and making it sore and watery. This is called entropion and can be corrected with surgery.
- Because the eyelids can become a bit lax and relaxed with age, the lower eyelids can droop outwards. Then tears just drop out of the eye instead of draining away down the tear ducts. This is called ectropion and can be corrected with surgery.
How tears work
Just above, and to the outer side of, each eye is a small gland called the lacrimal gland. This constantly makes a small amount of tears. When you blink, the eyelid spreads the tears over the front of the eye to keep it moist.
The tears then drain down tiny holes (called canaliculi) on the inner side of the eye into a tear sac. From here they flow down a channel called the tear duct (the nasolacrimal duct) into the nose. This diagram shows how tears usually drain away:
What tests do I need for watering eyes?
Usually the cause is easily identified - for example, infections, ectropion, entropion, and conjunctivitis. If there is no obvious cause revealed by a simple examination, further tests may be advised. These may depend on how bad the watering is, and how much it bothers you.
If a drainage problem is suspected, an eye specialist may examine the tear drainage channels, under local anaesthetic. They may push a thin stick (probe) into the small channels (canaliculi) towards the tear sac to see if it is blocked. If the probe goes as far as the tear sac then fluid can be syringed into the tear duct to see if it comes out in the nose.
Syringing may sometimes clear a blockage, but it may only give temporary relief. If there seems to be a blockage then a dye may be injected into the tear duct. An X-ray picture is then taken. You can see the dye in the duct on the X-ray film. It will show exactly where there is any obstruction or narrowing of the tear duct.
Treatment for watering eyes (epiphora)
Treating eye irritation
Quite often the cause of watery eyes can be treated. For example:
- Eyelashes irritating the front of the eye (entropion) can be removed.
- Conjunctivitis can usually be treated with drops.
- Pieces of grit, etc, can be removed.
Treating tear drainage problems
- Babies with watering eyes usually grow out of it with no treatment.
- Blockage of the channels in adults:
- You may not need treatment if the watering is mild or does not bother you much.
- A blocked tear duct can be treated with an operation. The usual operation is called dacrocystorhinostomy (DCR). A tiny probe is passed through the blocked tear duct and can unblock it.
- DCR surgery is worthwhile if the watering is bad enough to interfere with your activities of daily living. It is also recommended if you have had an infection in your tear sac as a result of the blocked tear duct. The surgery may prevent repeated attacks of a red, painful swelling at the corner of your eye.
- The surgery is not without its risks and should only be done if you fully understand the pros and cons.
- A narrowed small channel (canaliculus) which is not fully blocked may be widened by pushing in a probe.
Further reading and references
Shams PN, Chen PG, Wormald PJ, et al; Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy. JAMA Ophthalmol. 2014 Sep 1132(9):1127-32. doi: 10.1001/jamaophthalmol.2014.1093.
Nasolacrimal duct obstruction (nasolacrimal drainage dysfunction); College of Optometrists, March 2016
Alam MS, Kundu D; Is dacryocystectomy effective in reducing epiphora? Indian J Ophthalmol. 2022 Dec70(12):4416-4418. doi: 10.4103/ijo.IJO_972_22.