Watering eyes

Published by Bupa's Health Information Team, October 2010.

This factsheet is for people who have watering eyes, or who would like information about it.

Watering eye is when tears overflow and run down the cheek for no apparent reason. It's caused by too many tears or tears that aren't draining away properly.

About watering eyes

Your eyes need tears to keep them moist and healthy. Tears are produced by tear glands (lacrimal glands), which are underneath your upper eyelids, in the corner furthest away from your nose. When you blink, the tears from your tear glands are spread thinly all over the surface of your eye.

The tears drain away through tiny openings called puncta on the edge of your eyelids, near your nose. From here, they run through tear ducts into your nose and mouth.

If a problem occurs anywhere in this process, it can cause your eye to water and tears to run down your cheek.

Symptoms of watering eyes

Producing tears without cause, for example, when you're not upset or emotional, is the main symptom of watering eyes. You may only have the odd trickle down your cheek or tears may start rolling down your face. Other symptoms may include:

• your eyes watering more when you're outside in the wind or cold weather
• mucus, crusting or a sticky feeling in your eye
• pain or swelling at the inner corner of your eye near the bridge of your nose
• red and sore eyelid edges

Causes of watering eyes

Watering eyes are caused either by conditions where you produce too many tears, or by conditions where your tears can't drain away properly. If you're producing too many tears this is called lacrimation. If your tears aren't draining away properly this is called epiphora.

Lacrimation

There are a number of conditions that can cause your body to produce too many tears. Some of the main ones are listed below.

• Irritation. This can be due to grit, dirt or chemicals in your eye.
  
• Entropion. This is when the edge of your eyelid and eyelashes turn inwards and rub against the surface of your eyeball.
  
• Blepharitis. This is inflammation of the edge of your eyelid, which causes it to become red and sore.
  
• Dry eye. If you have dry eyes you don't have enough tears or your tears aren't capable of lubricating your eye properly.

However, your eyes can become sore because of this, which can cause a reaction in your tear ducts making them overproduce tears.

• Conjunctivitis. This is an inflammation of your conjunctiva (the transparent layer that covers the white of your eye and lines your eyelids). Inflammation causes the conjunctiva to become red and sore.
  
• Corneal abrasion. This is a scratch to the surface of your cornea (the clear dome-like structure at the front of your eye).
  
• An inflammation of your iris, the coloured part of your eye that surrounds your pupil (iritis).

Epiphora

Your eyes have a drainage system of tear ducts to take away your tears. If this drainage system becomes blocked or isn't working properly, it can cause your eyes to water. Tear ducts can become blocked if they are infected or inflamed, or as part of the ageing process or because of a blockage at the point where the tears drain out in your nose.

A blockage can lead to a condition called dacryocystitis. This is where an infection develops and causes a sometimes painful swelling in the corner of your eye near your nose. Injuries can cause scar tissue which can also block tear ducts. Some babies are born with blocked tear ducts, which usually get better in their first year.

If your tear duct openings aren't in the right place, for example if you have a condition called ectropion where your eyelid droops away from your eye, then your tears may not drain away properly.

Diagnosis of watering eyes

If you think you have watering eyes, you should visit your GP. He or she will ask about your symptoms and examine you. You GP may also ask you about your medical history.

If you have any discharge or pus coming from your eye, your GP may take a swab of it to see if you have an infection.

Your GP may refer you to an ophthalmologist, a specialist who identifies and treats eye conditions (including surgical treatments). He or she may arrange for you to have further tests.

Treatment of watering eyes

The type of treatment you have will depend on what is causing your eye to water. If your symptoms are mild, you may not need any treatment. Babies that are born with blocked tear ducts may not need any treatment.

Self-help

Keep the area around your eye and eyelids clean and clear of any crusting or stickiness. Using a hot compress can help to ease your symptoms. Put a warm compress over your eyelid for a few minutes. Use a towel soaked in hot water to make the compress. The water you use shouldn't be scalding hot - the compress should feel comfortable on your skin.

Medicines

If you have a mild infection, your GP may prescribe antibiotic eye drops or ointment. If your infection is more severe, your GP may prescribe antibiotic tablets. Dry eyes may need to be treated with artificial tears to keep the surface of the eye healthy - this will stop excessive tears from being formed and your eye from watering.

Punctal dilation

This procedure can be used to open up and clear any narrowing of the tear duct openings in your eyelids. Your ophthalmologist will put a few drops of a local anaesthetic into your eye to numb the area. He or she will then use a fine stainless steel pointed instrument to open up the openings of your tear ducts in your eyelids. Local anaesthetic completely blocks feeling from your eye area and you will stay awake during the procedure.

Lacrimal syringing

Sometimes the blockage is further down in your tear duct. Lacrimal syringing can be used to help determine where the blockage is. This is carried out under local anaesthesia. A local anaesthetic completely blocks feeling from your eye area and you will stay awake during the procedure. Your ophthalmologist may put some harmless yellow dye into your eye before syringing - this can help him or her decide whether the tear ducts are blocked.

Your doctor will put a very thin metal tube into your tear duct. This is connected to a syringe of salt water. He or she will wash the salt water through your tear duct to help remove the blockage or determine its location. When your doctor is doing this you may be able to taste salt in your mouth or feel it in your nose.

Surgery

If your tear ducts are blocked and other treatments don't work, you may be offered surgery to unblock the ducts and widen the tear duct opening your nose. The operation is called a dacryocystorhinostomy, or DCR. You may need to have special X-rays of the tear ducts before your surgery to help establish exactly where the blockage is and whether the surgery is likely to work.

A DCR operation can be done in two different ways. Your surgeon can get to your tear duct by going up through your nose using special instruments, or he or she can make a cut in the skin at the side of your nose.

Whatever the method, your surgeon will make a small hole in the bone between the tear sac and your nose. He or she will place small tubes in the hole to help it heal properly and to make sure the hole stays open. Your surgeon will take these tubes out a few weeks later.

Your surgeon may prescribe antibiotic eye drops and tablets to take after your operation, to help prevent an infection.

Video

See our video about watering eyes:

• How should I clean and care for my eyelids if I have an infection in them?

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.