Lacrimation (excess tearing) - Causes, Treatment & When to See a Doctor

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What is Lacrimation (excess tearing)?

Lacrimation refers to the production and secretion of tears from the lacrimal glands. While tearing is a normal protective reflex that keeps the eye surface moist and clears irritants, excess tearing (also called epiphora) occurs when tear flow overwhelms the normal drainage system or when the eye produces more tears than needed. This results in a watery, sometimes sticky discharge that may run down the cheeks, collect in the inner corners of the eyes, or create a “wet” appearance.

Epiphora can be physiologic (a normal response to wind, bright light, or emotional crying) or pathologic, stemming from an underlying ocular or systemic condition. Understanding the cause is essential because treatment ranges from simple home measures to surgical correction.

Common Causes

Below are the most frequent conditions that lead to persistent lacrimation. They are grouped by ocular, systemic, and environmental categories.

• Dry eye syndrome – Paradoxically, an insufficient tear film can trigger reflex tearing.
• Allergic conjunctivitis – Pollen, pet dander, or mold irritate the conjunctiva, prompting watery eyes.
• Blocked nasolacrimal duct – Congenital or acquired obstruction prevents normal tear drainage.
• Eyelid malposition – Ectropion (outward turning lid) or entropion (inward turning lid) alters tear flow.
• Infectious conjunctivitis – Bacterial, viral, or chlamydial infections produce a watery or purulent discharge.
• Blepharitis – Inflammation of the eyelid margin disrupts the tear film and can cause overflow.
• Exposure to irritants – Smoke, chemical fumes, windy environments, or bright light stimulate tearing.
• Contact lens wear – Poor fit or lens deposits cause ocular surface irritation.
• Eye surgery or trauma – Post‑operative inflammation or scar tissue may block drainage.
• Systemic diseases – Conditions such as Sjögren’s syndrome, thyroid eye disease, or neurologic disorders (e.g., Bell’s palsy) can affect lacrimal function.

Associated Symptoms

Excess tearing rarely appears in isolation. Patients often notice one or more of the following accompanying signs:

• Sensation of gritty or burning eye
• Redness of the sclera or conjunctiva
• Itching or swelling of the eyelids
• Crusty or sticky discharge, especially after sleep
• Blurred vision that improves after blinking
• Swelling around the inner corner of the eye (medial canthus)
• Pain or tenderness near the tear sac (puncta)
• History of recent upper respiratory infection or allergies

When to See a Doctor

While occasional tearing after a windstorm or crying is normal, persistent epiphora warrants medical attention—especially when any of the following are present:

• Watery discharge lasting more than one week without an obvious trigger
• Pain, swelling, or redness that worsens instead of improving
• Yellow, green, or pus‑like discharge suggesting infection
• Changes in vision (double vision, haziness, or sudden loss)
• Recurrent tearing after eye surgery or injury
• Associated facial weakness, drooping, or numbness
• Severe itching or a rash around the eyes indicating an allergic reaction

Diagnosis

Evaluation begins with a detailed history and a thorough eye examination. Typical steps include:

1. Medical history – Onset, duration, triggers, contact lens use, allergies, medications, and systemic illnesses.
2. Visual acuity test – Ensures tearing is not compromising vision.
3. Slit‑lamp examination – Allows the doctor to view the conjunctiva, cornea, eyelid margins, and tear film quality.
4. Fluorescein dye test – Highlights corneal abrasions or dryness that may provoke reflex tearing.
5. Nasolacrimal duct patency test – The fluorescein dye disappearance test or lacrimal syringing assesses drainage.
6. Eyelid and lash inspection – Detects ectropion, entropion, blepharitis, or lash misdirection.
7. Allergy testing – Skin prick or serum-specific IgE tests when allergic conjunctivitis is suspected.
8. Imaging (if needed) – CT or MRI for suspected sinus disease, tumors, or orbital fractures.

These assessments help differentiate a simple surface irritation from a structural blockage that may need surgery.

Treatment Options

Management is tailored to the underlying cause. Treatments fall into three broad categories: self‑care/home measures, pharmacologic therapy, and procedural/surgical interventions.

1. Home & Lifestyle Measures

• Warm compresses – 5–10 minutes, 2–3 times daily, especially for blepharitis or meibomian gland dysfunction.
• Lid hygiene – Gentle scrubbing with diluted baby shampoo or commercial lid wipes.
• Artificial tears – Preservative‑free drops can hydrate the surface and break the reflex‑tearing cycle.
• Avoid irritants – Use protective eyewear in windy or smoky environments; reduce screen glare.
• Allergy control – Keep windows closed during high pollen counts, use air filters, and rinse eyes with sterile saline.
• Proper contact lens care – Replace lenses as scheduled, clean with appropriate solution, and give eyes a break.

2. Medications

• Antihistamine eye drops or oral antihistamines – For allergic conjunctivitis (e.g., ketotifen, olopatadine).
• Topical antibiotics – For bacterial conjunctivitis (e.g., moxifloxacin, erythromycin ophthalmic ointment).
• Corticosteroid eye drops – Short‑term use for severe inflammation; must be prescribed and monitored.
• Lacrimal substitutes containing cyclosporine – Improves tear film in dry eye syndrome.
• Systemic treatments – In cases of autoimmune disease (e.g., hydroxychloroquine for Sjögren’s) or thyroid eye disease (e.g., steroids, teprotumumab).

3. Procedural & Surgical Options

• Lacrimal duct probing or intubation – Opens a blocked nasolacrimal duct, commonly performed in children or adults with congenital obstruction.
• Dacryocystorhinostomy (DCR) – Creates a new drainage pathway between the lacrimal sac and nasal cavity; indicated for chronic, refractory blockage.
• Eyelid surgery – Corrects ectropion, entropion, or eyelid laxity that interferes with tear flow.
• Meibomian gland expression or thermal pulsation (e.g., LipiFlow) – Improves lipid layer of tears, reducing evaporative dry eye and reflex tearing.
• Botulinum toxin injection – Occasionally used to reduce lacrimal gland secretion in severe reflex tearing.

Prevention Tips

Although some causes (e.g., congenital duct obstruction) cannot be avoided, many lifestyle changes reduce the risk of chronic epiphora:

• Maintain good eyelid hygiene; clean lids daily to prevent blepharitis.
• Use preservative‑free artificial tears if you have dry eye or spend long periods in air‑conditioned rooms.
• Wear sunglasses or wrap‑around glasses when outdoors to shield eyes from wind, UV light, and pollutants.
• Manage allergies with antihistamines and keep indoor air clean.
• Replace contact lenses as recommended and follow proper cleaning protocols.
• Stay hydrated; adequate systemic hydration supports healthy tear production.
• Seek prompt treatment for sinus infections or upper respiratory illnesses that can affect the nasolacrimal duct.

Emergency Warning Signs

Key Take‑aways

Lacrimation is a common symptom with a wide range of causes—from harmless environmental irritation to significant ocular or systemic disease. Understanding the pattern of tearing, accompanying signs, and personal risk factors helps you decide when self‑care is sufficient and when professional evaluation is necessary. If you notice persistent watering, especially with pain, vision changes, or purulent discharge, schedule an eye‑care appointment promptly. Early diagnosis and targeted treatment can restore comfort, protect vision, and prevent complications.

References:

• Mayo Clinic. “Epiphora (excessive tearing).” 2023.
• American Academy of Ophthalmology. “Dry Eye Disease.” 2022.
• Cleveland Clinic. “Allergic Conjunctivitis.” 2022.
• National Eye Institute (NEI). “Nasolacrimal Duct Obstruction.” 2021.
• World Health Organization. “Guidelines for the Management of Ocular Infections.” 2020.

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