Watery Eyes: Causes, Symptoms & Treatment

What Are Watery Eyes?

Watery eyes, medically termed epiphora, is a condition in which an excess of tears flows over the lower eyelid and down the cheek. While tear production is a normal and vital process that keeps the eye surface moist and protected, an imbalance between tear production and drainage can lead to persistent tearing. This condition can affect people of all ages, from newborns to the elderly.

Causes

Watery eyes can result from two main mechanisms: overproduction of tears or impaired drainage.

Overproduction of Tears

• Allergies (e.g., hay fever, pet dander allergy)
• Conjunctivitis (inflammation of the conjunctiva, caused by bacteria, viruses, or allergens)
• Eye irritation from wind, cold air, smoke, or bright light
• Foreign bodies in the eye (e.g., dust, eyelashes)
• Dry eye syndrome (paradoxical reflex tearing as a protective response)
• Emotional responses such as crying

Impaired Tear Drainage

• Narrowing or blockage of the tear ducts (dacryostenosis)
• Infection of the tear sac (dacryocystitis)
• Eyelid malposition such as ectropion (outward turning) or entropion (inward turning)
• Scarring from previous injuries or surgeries
• Tumors or polyps affecting the nasolacrimal drainage system

Symptoms

The main symptom is visible overflow of tears down the cheek. Associated symptoms may include:

• Redness or swelling of the eyelids
• Itching or burning sensation in the eye
• Crusting along the eyelid margins, especially in the morning
• Blurred vision due to an unstable tear film
• Pain or pressure near the inner corner of the eye (in cases of tear sac infection)

Diagnosis

Diagnosis is performed by an ophthalmologist (eye specialist). Common diagnostic methods include:

• Slit-lamp examination: Assessment of the eye surface and tear puncta
• Fluorescein dye test: Evaluation of tear drainage using a harmless dye
• Probing of the tear ducts: Checking for obstructions
• Dacryocystography: X-ray imaging of the tear ducts using contrast dye
• Swab cultures if an infection is suspected

Treatment

Treatment depends on the underlying cause:

Conservative Treatment

• Antihistamine eye drops or oral medications for allergy-related tearing
• Antibiotic eye drops for bacterial conjunctivitis
• Artificial tears to manage dry eye-related reflex tearing
• Avoiding triggers such as allergens, smoke, or wind exposure

Surgical Treatment

• Dacryocystorhinostomy (DCR): A surgical procedure that creates a new drainage pathway between the tear sac and the nasal cavity
• Probing and irrigation of the tear ducts for mild narrowing
• Eyelid correction surgery for malpositions such as ectropion

When to See a Doctor

Medical attention should be sought if watery eyes persist for more than a few days, are accompanied by significant pain, vision changes, purulent discharge, or swelling near the inner corner of the eye. In infants with continuously watery eyes, a pediatric ophthalmology evaluation is recommended.

References

1. American Academy of Ophthalmology (AAO): Preferred Practice Pattern - Conjunctivitis and Lacrimal System Disorders, 2022.
2. Kanski, J.J. & Bowling, B.: Clinical Ophthalmology: A Systematic Approach. 8th edition, Elsevier, 2016.
3. Olitsky, S.E. et al.: Disorders of the lacrimal system. In: Nelson Textbook of Pediatrics, 21st edition, Elsevier, 2020.