Understanding Watering Eyes (Epiphora): Causes, Symptoms, and Treatments

It was a crisp autumn morning when I decided to take a walk in the park with Julie, a friend from university. As we strolled along the leaf-laden paths, Julie kept dabbing at her eyes with a tissue. “Are you crying, Julie?” I teased, noticing the constant watering. She laughed but admitted, “I’ve had this problem for months. My eyes won’t stop watering, especially in the wind or cold.”

As a doctor, I immediately recognized her symptoms as epiphora, or watering eyes. This common condition can be caused by either excessive tear production or a problem with tear drainage. I shared my insights with Julie, hoping to reassure her and guide her toward the right treatment.

What Are Tears and How Do They Work?

Tears are essential for maintaining eye health. Produced by the lacrimal glands, tears are a mix of water, salt, proteins, and mucus. They serve several critical functions:

• Lubrication: Tears keep the surface of the eyes moist, preventing dryness and irritation.
• Protection: They wash away dirt, dust, and microorganisms, reducing the risk of infection.
• Nourishment: Tears provide essential nutrients to the cornea.

Once produced, tears drain through small openings called puncta, located in the corners of the upper and lower eyelids. From there, they pass through the nasolacrimal duct into the nose. When this delicate balance of production and drainage is disrupted, it can lead to excessive tear overflow.

What Causes Watering Eyes (Epiphora)?

Julie’s persistent tearing could stem from one of two primary causes:

1. Drainage Problems (Plumbing Faults):
   • Blocked or narrowed tear ducts are common in infants and older adults.
   • Age-related narrowing can result from infections, sinusitis, or scarring.
   • Eyelid deformities such as ectropion (outward-turning eyelids) can prevent tears from draining properly.
2. Overproduction of Tears:
   • Environmental Irritants: Wind, smoke, or bright light can stimulate tear production.
   • Dry Eye Syndrome: Poor-quality tears can paradoxically cause excessive tearing as the eyes try to compensate.
   • Allergies or Infections: Conditions like conjunctivitis can lead to irritation and tear overproduction.
   • Eye Strain: Prolonged screen time or reading can trigger watering.

In Julie’s case, the dry autumn air combined with potential eye strain from her work as a graphic designer were likely contributing factors.

Who Gets Watering Eyes?

Epiphora can affect anyone, but some groups are more susceptible:

• Infants: Narrow or underdeveloped tear ducts often resolve naturally by age 1.
• Older Adults: Age-related changes in the lacrimal system make this group particularly prone.
• People Exposed to Irritants: Those in dusty, windy, or smoky environments are at higher risk.
• Individuals with Certain Medical Conditions: Chronic sinusitis, conjunctivitis, or dry eye syndrome can increase the likelihood of epiphora.

What Are the Symptoms of Watering Eyes?

Julie described her symptoms as persistent tear overflow that blurred her vision. Common symptoms of epiphora include:

• Tears pooling on the cheeks and eyelids.
• Red, irritated eyes.
• Sticky discharge from the tear ducts (if infection is present).
• Blurred vision.
• Swelling near the eyes due to blocked tear drainage.

How Is Epiphora Diagnosed?

To diagnose watering eyes, an eye doctor may perform:

• Visual Inspection: Checking for redness, swelling, or signs of infection.
• Dye Tests: Using fluorescein dye to assess tear drainage.
• Imaging Tests: X-rays or CT scans to identify blockages in the tear ducts.

I encouraged Julie to consult an ophthalmologist for a thorough evaluation to pinpoint the exact cause of her symptoms.

What Are the Treatment Options?

Depending on the underlying cause, treatments for watering eyes include:

1. Addressing Drainage Problems:

• For Infants: Blocked tear ducts often resolve naturally by age 1. Gentle massage over the tear duct can help open it.
• For Adults:
  • Probing or flushing the tear ducts to clear blockages.
  • Surgery, such as dacryocystorhinostomy (DCR), to create a new drainage pathway for severe cases.

2. Managing Overproduction of Tears:

• Removing irritants such as dust or eyelashes.
• Treating infections with antibiotic eye drops.
• Prescribing antihistamines for allergies.
• Using artificial tears for dry eye syndrome.

Julie’s symptoms were likely due to environmental irritants and mild dry eye syndrome. I recommended starting with artificial tears and wearing protective sunglasses outdoors. If her symptoms persisted, she would need to follow up with an eye specialist.

Preventing Watering Eyes

To reduce the risk of epiphora, I shared the following tips with Julie:

• Protect Your Eyes: Wear sunglasses in windy or dusty conditions.
• Maintain Eye Hygiene: Avoid touching or rubbing your eyes with unclean hands.
• Take Breaks from Screens: Practice the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds.
• Stay Hydrated: Drink plenty of water to keep your eyes moist.
• Use a Humidifier: Especially in dry indoor environments.

Julie’s Journey

After our conversation, Julie felt reassured. She planned to implement the preventive measures and seek medical advice if her symptoms didn’t improve. A few weeks later, she reported significant relief from using artificial tears and limiting her screen time.

FAQs About Watering Eyes