Tears are needed to keep the front surface of the eye healthy and maintain clear vision. Too many tears can make it difficult to see, however.

Epiphora can develop at any age. It is, however, more common among babies aged under 12 months, and adults over the age of 60 years. The condition may present symptoms in just one or both eyes.

In most cases watering eye can be treated effectively. Depending on the severity of symptoms, watering eye can sometimes make driving difficult and dangerous.

There are two main causes of watering eyes – blocked tear ducts or excessive production of tears. Let’s look at each of these in turn.

Blocked tear ducts

Some humans are born with underdeveloped tear ducts. It is not uncommon for newborns to have watery eyes. Generally, this problem goes away within a few weeks as the ducts develop.

If a patient’s tear ducts are narrowed or blocked their tears will not be able to drain away and will build up in the tear sac. Stagnant tears in the tear sac increase the risk of infection in that area and the eye will produce a sticky liquid, further exacerbating the problem. Infection can also lead to inflammation on the side of the nose, next to the eye.

Narrow drainage channels on the insides of the eyes (canaliculi) can become blocked. This is caused by swelling or scarring.

Over-production of tears

Irritated eyes may produce more tears than normal as the body tries to rinse the irritant away.

The following irritants can cause the over-production of tears:

• Some chemicals, such as fumes, and even onions
• Infective conjunctivitis
• Allergic conjunctivitis
• An injury to the eye, such as a scratch or a bit of grit (tiny pebble or piece of dirt)
• Trichiasis – inward-growing eyelashes, often caused by marginal entropion (the eye lid turns in at the edges towards the eye)
• Ectropion – this is when the lower eyelid turns outwards.

The tears of some patients have a high fat (lipid) content. This may interfere with the even spread of liquid across the eye, leaving dry patches which become sore, irritated and cause the eye to produce more tears.

Other causes

There are many causes of watering eyes. The following conditions among others can also lead to an overflow of tears:

• Keratitis, an infection of the cornea
• Corneal ulcer, an open sore that forms on the eye
• Styes or chalazions, lumps that can grow on the edge of the eyelid
• Bell’s palsy
• Dry eyes
• Allergies, including hay fever
• A problem with glands in the eyelids called the Meibomian glands
• Use of certain medications

Diagnosis

If the GP cannot clearly determine the cause of the watering eye, the patient may be referred to an eye-care specialist doctor (ophthalmologist). The specialist will examine the patient’s eye(s) carefully – usually, the patient will be anesthetized.

A probe might be inserted into the narrow drainage channels on the inside of the eye (canaliculi) to see whether they are blocked.

Liquid may be inserted into a tear duct to find out whether it comes out of the patient’s nose. If it is found to be blocked, a dye may be injected to find the exact location of the blockage – this will be done by using an X-ray image of the area. The dye shows up on the X-ray.

Treatments

Treatment options depend on the severity of the epiphora and its causes. In mild cases doctors may recommend just watchful waiting – doing nothing and monitoring the patient’s progress.

Different causes of watering eyes have specific treatment options:

• Irritation: If the watering eye is caused by infective conjunctivitis the doctor may prefer to wait for a week or so to see if the problem resolves itself without antibiotics.
• Trichiasis: An inward-growing eyelash, or some foreign object that lodged in the eye, the doctor will remove it.
• Ectropion: The eyelid turns outwards – the patient may need to undergo surgery in which the tendon that holds the outer eyelid in place is tightened.
• Blocked tear ducts: Surgery which creates a new channel from the tear sac to the inside of the nose may be necessary. This allows the tears to bypass the blocked part of the tear duct. This surgical procedure is called DCR (dacryocystorhinostomy).

If the drainage channels on the inside of the eye (canaliculi) are narrowed, but not entirely blocked, the doctor may use a probe to make them wider. When the canaliculi are completely blocked an operation may be required.

In the majority of cases the condition resolves itself on its own within a few weeks. Sometimes a sticky liquid may form around the baby’s eye(s). In such cases, using a piece of cotton wool that has been soaked in sterile water can be used to clean the eye(s). Sterile water needs to be boiled – make sure it is cooled before dipping the cotton wool into it.

Sometimes tears can be dislodged if you gently massage the tear ducts. Apply light pressure with the finger and thumb to the outside of the baby’s nose.