Epiphora

Page last reviewed: 13/07/2011

Watering eyes is when tears are produced without any obvious reason.

It is caused when tears don't drain away properly (epiphora) or too many tears are produced (hypersecretion).

Epiphora and hypersecretion can occur as a result of conditions such as conjunctivitis (eye inflammation), an eye injury, 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 the small gland located above and outside each eye, called the lacrimal gland, and in the small cells found in the membrane that covers the eyeball (conjunctiva). When you blink, tears are spread over the front of your eyes.

The tears drain away through tiny channels known as canaliculi, which are found on the inside of your eyes. The tears drain into a tear "sac" before flowing down a tube and into your nose.

Blocked tear duct

If your tear ducts become blocked or narrowed, or if you have an eye infection, excess tears can build up. This causes the tear ducts to overflow, leading to a watering eye. If you have a blocked tear duct, your eye may water at least 10 times a day.

Who is affected by watering eyes?

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 eyelid skin and sticky eyes. 

Treatment

Treatment isn't always necessary for watering eyes and mild cases may not need treatment at all. 

It depends on how severe your watering eyes are and what is causing it. For example, if you have a blocked tear duct, surgery may be required to unblock it. See more about treating watering eyes.

Page last reviewed: 13/07/2011

Blocked tear ducts

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

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 that they might have an eye infection.

If your baby's eyes are still watering after the age of one, they may need to have a small procedure done 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.

Blocked tear ducts in adults

In adults, a blocked or narrowed tear duct is the most common cause of a watering eye. Over time, the tear ducts can become narrowed, often as a result of inflammation (swelling). This can occur more often with sinus disease and allergy, as well as with old age.

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 tear sac may become infected and your eye will produce a sticky liquid (mucus).

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) can become blocked. This can be caused by inflammation or scarring due to a viral infection, trauma or another form of damage.

Excess tears

If your eyes become irritated, they will automatically produce extra tears to wash away the irritant. This is called over-watering or hypersecretion. Irritants 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-growing eyelash (entropion)

Related eye conditions

There are several eye conditions that may cause excess tears to develop or your tear ducts to become blocked. Some of these are briefly outlined below.

Uveitis 

Inflammation of the middle part of your eye (uveitis) can also cause your eye to water. This may be the result of an injury, infection or an underlying health condition. Uveitis may also cause other symptoms, such as redness or pain.

Ectropion

A watering eye can also be caused when the lower eyelid turns outwards away from the eye. This is known as ectropion. If this happens, your tears may not drain away properly.

Abnormal tears

Tears are made up of different substances including water, proteins and fats. If your tears have an abnormal fat 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. Your eyes may be red and feel gritty or sore. Sometimes, they can also water.

Blepharitis

Blepharitis is a condition where the rims of your eyelids become inflamed, resulting in your eyes stinging or itching. 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 you to have watering eyes.

Page last reviewed: 13/07/2011

If you already have a diagnosed eye condition, such as conjunctivitis (eye inflammation) or an inward-growing eyelash, it may be related to your watering eyes (see causes of watering eyes).

If the cause is not obvious, your GP may refer you to an ophthalmologist (an eye care specialist).

Referral to an ophthalmologist

The ophthalmologist will examine your eyes using local anaesthetic eye drops to help numb them. They will then be able to check for blockages in your tear ducts.

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 is felt in your throat.

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.

If your tear duct is blocked, the ophthalmologist may pass a special fluid down into your tear duct to help pinpoint the location of the blockage. After the fluid has been added, an X-ray will be taken to highlight the blockage.

Page last reviewed: 13/07/2011

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

Treating irritation

If infective conjunctivitis is causing watering eyes, your GP may advise you to wait for a week or so to see if the condition resolves itself before prescribing a course of antibiotics.

If allergic conjunctivitis is causing watering eyes, antihistamines (medication to treat allergic conditions) may be prescribed to help reduce the inflammation (swelling).

Read more about treating conjunctivitis.

If your watering eyes are being caused by an inward-growing eyelash (entropion), or a foreign object, such as a piece of grit in your eye, the eyelash or object 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.

Read more about treating ectropion.

Surgery for blocked tear ducts

Tear ducts are the tubes that excess tears drain away through. 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 will be required.

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

Dacryocystorhinostomy (DCR for short) is a common surgical procedure that is 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.

A DCR is often carried out via the nose. Before having surgery, your nose will be examined to check the nasal space and that the lining of the nose is healthy. 

There are several different ways that a new channel can be created. For example, by:

  • removing a very small piece of bone from the side of your nose, either by making a small incision in the skin of your nose or from inside the nose, allowing the sac to be opened up; an endoscope (a narrow, flexible tube with a light at the end) is often used during the procedure (endoscopic endonasal DCR)
  • using a laser to create a similar but smaller hole in the sac and bone between the sac and the nose; this can be done either from inside or outside the tear sac
  • using a balloon to expand the blocked tear duct

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

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

After surgery

After having a dacryocystorhinostomy, you may need to stay in hospital overnight. You should be given instructions to follow when you are discharged - for example, not to rub your eyes or blow your nose. You may also be given some eye drops or ointment to use to prevent infection and inflammation.

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 will usually be minor and should stop in due course.

Blocked canaliculi

If the drainage channels on the inside of your eye (canaliculi) are narrowed but not completely blocked, it may be possible to use a probe to widen them. If the canaliculi are completely blocked by tears, an operation to drain them may be required, involving a small glass tube (called the Jones Tube) being inserted to bypass the blockage and drain the tears.

Treating watering eyes in babies

In babies, watering eyes often resolves 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

If the tear duct does not open, it may be possible for your baby to have a procedure where a probe is used to open their tear duct. This will be carried out under general anaesthetic.

Probing is not usually necessary because in 9 out of 10 cases, the tear duct opens by itself. However, a probe can be used if your child has repeated infections caused by the blocked tear duct and he or she is over a year old. Very occasionally a dacryocystorhinostomy operation is required (see above).

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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