Excessive tearing, also called epiphora, can happen when the eyes produce too many tears, when tears do not drain properly, or when eyelid problems interfere with normal tear flow. Watery eyes may be caused by blocked tear ducts, dry eye, eyelid malposition, poor blinking, irritation, allergies, thyroid eye disease, or a combination of factors.
At Fante Eye & Face Center, patients from Denver, Greenwood Village, and surrounding Colorado communities receive evaluation and treatment for tearing problems from doctors with specialized training in eyelid function, tear drainage, orbital disease, and oculofacial plastic surgery. Dr. Robert Fante is double board-certified and has co-authored a major published series on DCR tear duct surgery, while both Dr. Levitt and Dr. Huang are ASOPRS-trained surgeons and ASOPRS Candidate Members. This experience helps the team identify the cause of watery eyes and recommend treatment that may include dry eye care, eyelid surgery, tear duct procedures, or other options.
How Do Tears Normally Drain?
Tears are produced by glands around the eyes and spread across the eye surface with each blink. Blinking moves tears toward small drainage openings in the inner corners of the eyelids, where tears pass through tiny ducts and eventually drain into the nose. When any part of this system is blocked or not working properly, tears may pool in the eye or run down the face.
Common Causes of Watery Eyes
Watery eyes can have several causes, and some patients have more than one contributing factor. The most common causes include blocked tear drainage, eyelid problems, poor blinking, and dry eye.
Blocked Tear Drainage
When the tear drainage system is blocked, tears cannot drain normally from the eye into the nose. Instead, they pool in the eye and may run down the face. Blockage can occur at the drainage openings, along the tear ducts, or deeper in the system.
In infants, blocked tear ducts often improve with gentle massage and time, though probing or temporary stent placement may be needed if tearing and mucus persist. In older children and adults, treatment depends on the location of the blockage. A minor office procedure may open a closed punctum, while deeper blockages may require more involved treatment, especially if infections, redness, pus, or swelling are present.
Eyelid or Blinking Problems
Even when the tear drainage system is open, tears may overflow if blinking does not move them properly toward the inner corner of the eye. This can happen when age-related looseness causes the lower eyelid to sit too low or pull away from the eye.
In these cases, outpatient eyelid surgery may help restore better eyelid position and improve tear movement.
Dry Eye and Irritation
Dry eye can also cause excess tearing. When the eye surface becomes dry or irritated, the body may respond by producing reflex tears. These tears can overflow, even though the underlying problem is dryness.
Dry eye is common in Colorado’s dry climate and can become more noticeable with age. Treatment may include artificial tears or other therapies to improve tear quality and comfort. Eyelid surgery is not usually needed, but it may help certain patients when eyelid position or blinking problems contribute to dryness and tearing.
Additional Causes
Watery eyes can also occur after trauma or surgery near the eyes, including certain facial fracture repairs or cosmetic procedures beneath the eyes. In some cases, scarring of the lower eyelid can limit normal blinking or prevent the eyelid from resting properly against the eye, leading to irritation and tearing. Reconstructive eyelid surgery may help when eyelid position or movement is contributing to the problem.
Floppy eyelid syndrome can also cause morning redness, irritation, and tearing, especially in people with sleep apnea or those who sleep face down. When the eyelids are unusually loose, they may open or turn outward during sleep, exposing the eyes to air or the pillow. CPAP treatment, eye ointments, or eyelid surgery may be recommended depending on the severity of symptoms.
Can Thyroid Eye Disease Cause Excessive Tearing?
Thyroid Eye Disease can cause the eyelids to widen and often reduces blinking. It can also cause swelling and irritation behind the eye and on the eye’s surface. All of this contributes to excess tearing. The proper treatment depends on the phase of the disease.
Symptoms of Blocked Tear Ducts and Eyelid-Related Tearing
Symptoms may include:
- Excessive or frequent tearing
- Redness of the white part of the eye
- Recurrent eye infection or inflammation
- Painful swelling near the inner corner of the eye
- Crusting of the eyelids
- Mucus or pus discharge from the eyelids or the eye surface
- Blurred vision
Any cause of facial paralysis, from Bell’s palsy to acoustic neuroma, can also reduce the efficiency of blinking, and create excess tearing. Again outpatient day surgery to improve eyelid closure and tension can help to solve the tearing problem.
At What Point Should I See a Doctor for My Watery Eyes?
Watery eyes can clear up on their own, especially due to environmental factors. However, if the tearing is frequent throughout the day or lasts for weeks, watery eyes can sometimes lead to more serious problems.
What Can I Expect During My Evaluation for Watery Eyes?
During your evaluation, our doctors will review your symptoms, including when tearing started, whether it has changed over time, and whether you have other eye or medical concerns. They will examine the eyes, eyelids, tear drainage openings, blinking function, and, when needed, the inside of the nose.
Additional testing may include:
- Tear drainage testing
- Irrigation and probing of the tear drainage system
- Nasal examination
- Imaging such as an X-ray, CT scan, or MRI
These tests help determine whether tearing is caused by a blocked tear duct, eyelid problem, dry eye, irritation, nasal issue, or another cause.
Watery Eyes Treatment
Treatment for watery eyes depends on the cause. Some patients need dry eye treatment, artificial tears, medications, or management of irritation. Others may need eyelid repair, tear duct opening, tear duct bypass surgery, or treatment for an underlying condition such as thyroid eye disease or facial paralysis.
Evaluation by an optometrist or ophthalmologist may be enough to identify the problem and begin treatment. When tearing is related to the eyelids, the tear drainage system, the orbit, or prior surgery, referral to an oculofacial plastic surgery specialist may be recommended for a more comprehensive evaluation.
Surgery for Epiphora
As highlighted above, there are several different outpatient procedures used to solve the various different problems that cause excessive tearing. Depending on the patient and procedure, these are usually performed with conscious sedation or general anesthesia in an ambulatory surgery center or hospital. In some cases. surgery is needed to correct excessive tearing including upper/lower eyelid surgery or tear duct surgery.
Eyelid Surgery
Eyelid surgery is one method our doctors may use to treat tearing problems. In some patients, the eyelids are not tight enough to the eye, causing tears to drain improperly. The tearing system relies on the muscles of the eyelid to open and close the tear duct, which cannot happen if the eyelids are too loose. For blepharoplasty or eyelid surgeries, there is usually minimal pain but some swelling, bruising, and stitches are common. Most people can return to work or everyday life about a week after surgery.
Tear Duct Surgery
Outpatient day surgery is often necessary to restore tear flow through the normal channels or to bypass the blockage and deliver the tears to the nose, often with the placement of a temporary soft silicone plastic stent. The most commonly performed surgery is called DCR (for DacryoCystoRhinostomy). Dr. Robert Fante is the co-author of one of the largest published series of DCR surgeries in America, and the team at Fante Eye & Face Center has extensive experience evaluating and treating tear drainage disorders.
For the tear duct surgeries, there is also usually minimal pain. Many of these are accomplished using a nasal endoscope, and afterward, there is no swelling or bruising, but there is often a bloody nose for a few hours. People are able to return to work or everyday life within a few days. Other kinds of tear duct surgery are performed in the inner corner of the eye itself, and then there is often temporary swelling, bruising, and stitches that may delay return to work until a week after surgery.
Who is a Candidate for Tear Duct Surgery?
Because blocked tear ducts are among the most common causes of watery eyes, it may be necessary to perform what is called a dacryocystorhinostomy (DCR). In these procedures, your surgeon creates a new tear drain between the eye and the nose.
This can be necessary if we’ve determined your tear ducts are blocked and there isn’t a non-invasive treatment option to correct the problem. These surgeries are far more common for adults than children with blocked tear ducts. In most cases, surgery won’t be pursued unless it is clear that non-surgical options such as warm compresses, massage, and antibiotics to clear an infection have been tried and proven unsuccessful for opening the blockage.
What Are the Risks With Tear Duct Surgery?
This is a commonly performed surgery that can be done using a small skin incision near the inner corner of the eye or using an endoscope to access the blocked area from the nose. Either way, it is an outpatient surgery and you go home the same day. Often a temporary stent or tube is placed inside the tear duct to help it heal well. The stent is typically removed in the office 6-12 weeks later. Tear duct surgery is successful 90-99% of the time, depending on the cause, and most people have no complications.
Uncommon risks of these surgeries include:
- Incomplete resolution of the tearing
- Scarring
- Displacement of the stent placed in the duct
- Excessive bleeding from the nose in first few days
- Infection
A thorough exam by your eye doctor will help you determine if your frequent tearing might be from an eyelid problem, a blocked tear drainage duct, or from dry eyes. You might even have all three. When you visit Fante Eye & Face Center, we will work with your doctor to find the best solution(s) to your watery eyes, and we will be certain to make sure you understand the details.
What People Say About Us!
Click here to read more reviews.