What Is Excessive Tearing?
Excessive tearing — also called epiphora or watering eyes — is a condition in which tears spill onto the cheeks even when you are not crying. While occasional tearing is a normal protective response, persistent watering can signal an underlying problem with tear production, tear drainage, or eyelid positioning that requires professional evaluation.
Excessive tearing is one of the most common eye complaints evaluated at West Boca Eye Center in Boca Raton. Although the condition is rarely dangerous, chronic watering can blur vision, irritate the surrounding skin, and significantly affect quality of life.
How the Tear System Works
Understanding why excessive tearing occurs starts with how the tear system functions. Your eyes produce two types of tears:
- Lubricating (basal) tears — a thin film that coats the eye surface continuously, keeping it moist and nourished
- Reflex tears — produced in response to irritation, emotion, bright light, or foreign objects
Tears drain from the eye surface through two tiny openings called puncta, located at the inner corners of the upper and lower eyelids. From there, tears travel through narrow channels called canaliculi into the lacrimal sac and down through the nasolacrimal duct into the nose. A problem at any point in this production-to-drainage pathway can cause excessive tearing.
Causes of Excessive Tearing
Excessive tearing generally falls into two categories: overproduction of reflex tears or inadequate drainage.
Overproduction of Reflex Tears
When the eye surface is irritated or inadequately lubricated, the lacrimal glands respond by flooding the eye with reflex tears. Common triggers include:
- Dry eye syndrome — paradoxically, eyes that do not produce enough lubricating tears often compensate with excessive reflex tears
- Allergies — seasonal or environmental allergens such as pollen, pet dander, and dust mites
- Blepharitis — chronic inflammation along the eyelid margins
- Foreign bodies — dust, sawdust, or small debris on the eye surface
- Environmental irritants — smoke, wind, chemical fumes, and air pollution
- Corneal abrasion — a scratch on the corneal surface
- Conjunctivitis — viral, bacterial, or allergic inflammation of the conjunctiva
Blocked or Impaired Tear Drainage
Even when tear production is normal, a blockage anywhere in the drainage pathway prevents tears from leaving the eye surface efficiently. Causes of blocked drainage include:
- Nasolacrimal duct obstruction — narrowing or complete blockage of the tear duct, often age-related
- Punctal stenosis — narrowing of the puncta openings due to aging, chronic inflammation, or certain medications
- Congenital obstruction — some infants are born with a membrane blocking the nasolacrimal duct
- Chronic sinus infections — scarring from repeated sinus infections can block drainage
- Eyelid malposition — conditions like ectropion (outward-turning lid) or entropion (inward-turning lid) prevent tears from reaching the drainage puncta
- Trauma or prior surgery — injury to the eye, nose, or surrounding structures can damage drainage channels
- Certain medications — some chemotherapy drugs and topical eye medications can cause duct scarring
Symptoms of Excessive Tearing
The primary symptom is tears overflowing from the eyes onto the cheeks. Additional signs that often accompany excessive tearing include:
- Blurred or fluctuating vision caused by the excess tear film
- Redness or irritation around the eyelids and cheeks
- Mucus or discharge in the corner of the eye (especially with infection or duct blockage)
- Swelling near the inner corner of the eye (possible dacryocystitis if the lacrimal sac is infected)
- Crusting along the eyelid margins
- Symptoms that worsen in windy, cold, or dry environments
Excessive tearing may affect one eye or both. Unilateral tearing is more common with duct blockages or corneal injuries, while bilateral tearing is more typical of allergies, dry eye syndrome, and environmental irritants.
How Excessive Tearing Is Diagnosed
At West Boca Eye Center, the diagnostic process begins with a thorough history and comprehensive eye examination. Your ophthalmologist will evaluate:
- Tear film quality — to determine whether reflex overproduction from dry eye is the underlying cause
- Eyelid position and function — checking for ectropion, entropion, or incomplete lid closure
- Corneal surface — using fluorescein dye to reveal abrasions, infections, or surface irregularities
- Punctal patency — probing and irrigating the puncta to test whether the drainage channels are open
- Lacrimal sac — palpating the area near the inner eye corner to check for swelling, tenderness, or infection
In some cases, imaging such as a dacryocystogram (a contrast dye X-ray of the tear drainage system) may be ordered to pinpoint the exact location of a blockage.
Treatment Options for Excessive Tearing
Treatment depends entirely on the underlying cause. Dr. Brent Bellotte and the team at West Boca Eye Center take a targeted approach — identifying the root cause first, then selecting the most appropriate treatment.
Treating Reflex Overproduction
When excessive tearing results from eye surface irritation or inadequate lubrication, treatment focuses on resolving the trigger:
- Artificial tears — lubricating eye drops or ointments to address underlying dry eye syndrome
- Allergy management — antihistamine eye drops, avoiding known allergens, and using air purifiers
- Antibiotic drops or ointment — for bacterial infections such as blepharitis or bacterial conjunctivitis
- Warm compresses and lid hygiene — to manage blepharitis and meibomian gland dysfunction
- Environmental modifications — wearing wrap-around sunglasses outdoors and using humidifiers indoors
Treating Drainage Blockages
When a structural blockage prevents normal tear drainage, procedural or surgical intervention may be recommended:
- Punctal dilation — a simple in-office procedure to widen narrowed puncta openings
- Punctal plugs (in reverse) — while punctal plugs are typically used to block drainage for dry eye patients, removing previously placed plugs can restore drainage for patients with overflow tearing
- Balloon dacryoplasty — a minimally invasive procedure in which a small balloon catheter is threaded into the nasolacrimal duct and inflated to widen the blocked passage
- Nasolacrimal duct stenting — placing a thin silicone tube through the drainage system to keep the passage open during healing
- Dacryocystorhinostomy (DCR) — a surgical procedure that creates a new drainage pathway between the lacrimal sac and the nasal cavity, bypassing the blocked duct entirely
Eyelid Correction
If excessive tearing is caused by eyelid malposition, oculoplastic surgery may be recommended to reposition the lid so that tears drain properly. Common procedures include ectropion repair and entropion repair.
Prevention and Self-Care
While not all causes of excessive tearing are preventable, these measures can reduce symptoms and protect your eyes:
- Wear protective eyewear during work, sports, or activities where debris could enter the eye
- Manage allergies proactively with antihistamines and environmental controls
- Practice good eyelid hygiene — clean the lid margins daily if you are prone to blepharitis
- Use preservative-free artificial tears regularly if you have dry eye syndrome
- Wear sunglasses that block UV radiation and shield against wind
- Avoid rubbing your eyes, which can worsen irritation and introduce bacteria
- Schedule regular comprehensive eye exams every one to two years
When to See a Doctor for Excessive Tearing
Occasional watery eyes from wind, cold air, or a brief irritant usually resolve on their own. Schedule an evaluation at West Boca Eye Center if you experience:
- Tearing that persists for more than a few days without an obvious cause
- Redness, pain, or swelling near the inner corner of the eye
- Mucus or pus discharge accompanying the tearing
- Vision changes or blurriness that does not clear with blinking
- Tearing in only one eye (which may indicate a duct blockage or corneal injury)
- A history of sinus problems or prior facial trauma
West Boca Eye Center is located at 9325 Glades Road, Suite 201, Boca Raton, FL 33434. Call (561) 488-1001 to schedule your appointment.
Frequently Asked Questions About Excessive Tearing
What causes excessive tearing in one eye?
Excessive tearing in one eye is most commonly caused by a nasolacrimal duct blockage, a corneal abrasion, or a localized infection. Because these conditions typically affect one side, unilateral tearing warrants an eye exam to identify the specific cause and determine whether procedural treatment is needed.
Is excessive tearing a sign of dry eye?
Yes. Paradoxical tearing is one of the most common symptoms of dry eye syndrome. When the eyes do not produce enough lubricating tears, the lacrimal glands respond by flooding the eye with watery reflex tears — which do not have the same lubricating quality and overflow onto the cheeks.
Can excessive tearing be treated without surgery?
Many cases of excessive tearing respond to non-surgical treatments including artificial tears, allergy medications, antibiotic drops, warm compresses, and lid hygiene. Surgery is typically reserved for structural blockages or eyelid malposition that do not improve with conservative care.
What is a dacryocystorhinostomy (DCR)?
A dacryocystorhinostomy is a surgical procedure that creates a new drainage channel between the lacrimal sac and the nasal cavity. It is performed when the nasolacrimal duct is fully blocked and non-surgical methods have not provided relief. The procedure is highly effective and can be performed through an external incision or endoscopically through the nose.
When should I see an ophthalmologist for watery eyes?
You should schedule an evaluation if tearing lasts more than a few days, is accompanied by pain, redness, or discharge, affects your vision, or occurs in only one eye. An ophthalmologist can determine whether the cause is irritation-based or structural and recommend the appropriate treatment.
