Watering eye, epiphora or tearing, is a condition in which there is an overflow of tears onto the face, often without a clear explanation.
There is insufficient tear film drainage from the eye or eyes. Instead of the tears draining through the nasolacrimal system, they overflow onto the face.
Tears are needed to keep the front surface of the eye healthy and maintain clear vision, but too many tears can make it difficult to see. This can make driving difficult or dangerous.
Epiphora can develop at any age, but it is more common in those aged under 12 months or over 60 years. It may affect one or both eyes.
Watering eye can usually be treated effectively.
The two main causes of watering eyes are blocked tear ducts and excessive production of tears.
Blocked tear ducts
Some people are born with underdeveloped tear ducts. Newborns often have watery eyes that clear up within a few weeks, as the ducts develop.
The most common cause of watering eyes among adults and older children is blocked ducts or ducts that are too narrow. Narrowed tear ducts usually become so as a result of swelling, or inflammation.
If the tear ducts are narrowed or blocked, the 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, and the eye will produce a sticky liquid, making the problem worse. 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, where eyelashes grow inward
- ectropion, when the lower eyelid turns outward
Some people have tears with a high fat, or 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.
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
Treatment depends on how severe the problem is and the cause.
In mild cases, doctors may recommend just watchful waiting, or 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 can create a new channel from the tear sac to the inside of the nose. This allows the tears to bypass the blocked part of the tear duct. This surgical procedure is called dacryocystorhinostomy (DCR).
If the drainage channels, or canaliculi, on the inside of the eye 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.
Watering eyes in babies
In newborns, the condition usually resolves itself within a few weeks.
Sometimes a sticky liquid may form around the baby's eye or eyes. You can use a piece of cotton wool that has been soaked in sterile water to clean the eyes.
Sterile water needs to be boiled, but make sure it is cooled before dipping the cotton wool into it.
Sometimes tears can be dislodged by gently massaging the tear ducts. Apply light pressure with the finger and thumb to the outside of the nose.
Some cases of watering eyes can be treated without seeing a doctor.
Here are some suggestions:
- take a break from reading, watching TV, or using the computer
- lubricate the eyes with eye drops, available to purchase over-the-counter (OTC) or online.
- hold a warm, damp cloth over the eyes and massage the eyelids to release any blockages
If the following symptoms occur, the person should see a doctor:
- reduced vision
- pain or swelling around the eyes
- a feeling that something is in the eye
- persistent redness in the eye
Epiphora is fairly easy to diagnose. The doctor will try to find out whether it has been caused by a lesion, infection, entropion (inward-turning eyelid) or ectropion (outward-turning eyelid).
In some cases, the patient may be referred to an eye-care specialist doctor, or ophthalmologist, who will examine the eyes, possibly under anesthetic.
A probe might be inserted into the narrow drainage channels on the inside of the eye 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.