Excessive Tears: Causes, Symptoms, and Treatment

What is Excessive Tears?

Excessive tearing, medically known as epiphora, occurs when there is an overflow of tears onto the face, often without a clear reason. Tears are essential for maintaining eye health—they lubricate the eyes, wash away foreign particles, and contain enzymes that protect against infections. Normally, tears drain through small openings (puncta) in the corners of the upper and lower eyelids into the nasal passage. When this drainage system is disrupted or when tear production increases abnormally, excessive tearing can result.

While occasional tearing is normal—especially in response to emotions, wind, or irritants—persistent or unexplained excessive tearing may indicate an underlying issue that requires medical attention.

Common Causes

Excessive tearing can stem from a variety of causes, ranging from minor irritations to more serious medical conditions. Below are some of the most common causes:

• Blocked Tear Ducts: A blockage in the tear drainage system (nasolacrimal duct) can prevent tears from draining properly, leading to overflow. This is common in newborns but can also occur in adults due to infections, injuries, or tumors.
• Dry Eye Syndrome: Paradoxically, dry eyes can cause excessive tearing. When the eyes are too dry, the lacrimal glands may overproduce tears to compensate for the lack of moisture.
• Eye Infections: Conditions like conjunctivitis (pink eye), blepharitis (eyelid inflammation), or corneal ulcers can cause irritation and increased tear production.
• Allergies: Allergic reactions to pollen, dust, pet dander, or other allergens can lead to itchy, watery eyes as the body releases histamines.
• Foreign Objects or Irritants: Dust, sand, eyelashes, or chemical irritants (e.g., smoke, onions, or fumes) can trigger excessive tearing as the eyes attempt to flush out the irritant.
• Eyelid Problems: Conditions like ectropion (outward-turning eyelid) or entropion (inward-turning eyelid) can disrupt the normal tear film and drainage, leading to tearing.
• Corneal Abrasions or Injuries: Scratches or injuries to the cornea can cause significant pain, redness, and tearing as the eye attempts to heal.
• Chronic Sinusitis or Nasal Polyps: Inflammation or blockages in the nasal passages can affect tear drainage, leading to epiphora.
• Neurological Conditions: Rarely, conditions like Bell’s palsy (facial nerve paralysis) or other neurological disorders can interfere with eyelid function and tear production.
• Medications: Certain medications, such as chemotherapy drugs, epinephrine, or eye drops (e.g., echothiophate for glaucoma), can increase tear production as a side effect.

Sources: Mayo Clinic, American Academy of Ophthalmology (AAO), National Eye Institute (NEI).

Associated Symptoms

Excessive tearing is often accompanied by other symptoms, which can help identify the underlying cause. Common associated symptoms include:

• Redness or swelling of the eyes or eyelids.
• Itching or burning sensation in the eyes.
• Blurred or impaired vision.
• Discharge from the eyes (clear, white, yellow, or green).
• Sensitivity to light (photophobia).
• Pain or discomfort in or around the eyes.
• Crusting of the eyelids or lashes, especially upon waking.
• Frequent eye rubbing or a gritty sensation.
• Nasal congestion or sinus pressure (if related to allergies or sinusitis).

If you experience any of these symptoms alongside excessive tearing, it’s important to note their duration and severity, as this information can assist your doctor in diagnosing the issue.

When to See a Doctor

While occasional tearing is usually harmless, you should consult a healthcare professional if you experience any of the following:

• Persistent tearing that lasts more than a few days without improvement.
• Tearing accompanied by pain, vision changes, or significant redness.
• Discharge from the eye that is thick, yellow, or green (possible sign of infection).
• Swelling around the eyes or face.
• Trauma or injury to the eye.
• Symptoms that interfere with daily activities, such as driving or reading.
• Tearing in an infant that persists beyond a few weeks or is accompanied by redness or discharge.

Early evaluation can help prevent complications, especially if the cause is an infection, blockage, or structural issue.

Diagnosis

To determine the cause of excessive tearing, your doctor will likely perform a combination of the following evaluations:

• Medical History: Your doctor will ask about your symptoms, duration, triggers (e.g., allergens, irritants), and any history of eye conditions or injuries.
• Physical Examination: A thorough eye exam will be conducted to check for redness, swelling, discharge, or structural abnormalities in the eyelids or tear ducts.
• Tear Drainage Test: A dye may be placed in your eye to observe how well tears drain. If the dye remains visible after a few minutes, it may indicate a blockage.
• Imaging Tests: In some cases, imaging such as a CT scan or MRI may be ordered to assess the tear drainage system or rule out tumors or nasal polyps.
• Allergy Testing: If allergies are suspected, skin prick tests or blood tests may be recommended to identify specific allergens.
• Eye Culture: If an infection is suspected, a sample of eye discharge may be collected and sent to a lab for analysis.

Based on these evaluations, your doctor can diagnose the underlying cause and recommend appropriate treatment.

Treatment Options

The treatment for excessive tearing depends on the underlying cause. Below are common approaches:

Medical Treatments

• Antibiotics: If a bacterial infection (e.g., conjunctivitis) is the cause, antibiotic eye drops or ointments may be prescribed.
• Antihistamines or Mast Cell Stabilizers: For allergy-related tearing, oral antihistamines or eye drops (e.g., ketotifen, olopatadine) can help reduce symptoms.
• Artificial Tears: Lubricating eye drops can relieve dryness and reduce reflex tearing.
• Steroid Eye Drops: In cases of severe inflammation, short-term use of steroid drops may be prescribed.
• Probing or Surgery: For blocked tear ducts, a doctor may perform a procedure to open the duct. In infants, this is often done with a simple probing technique. Adults may require more extensive surgery, such as dacryocystorhinostomy (DCR), to create a new drainage pathway.
• Eyelid Repair: If ectropion or entropion is causing the issue, surgical correction may be necessary.

Home and Lifestyle Remedies

• Avoid Irritants: Protect your eyes from wind, smoke, dust, and other irritants by wearing sunglasses or protective goggles.
• Warm Compresses: Applying a warm, damp cloth to the eyes can help unclog tear ducts and relieve discomfort from infections or blockages.
• Proper Eye Hygiene: Gently clean your eyelids with a mild, tear-free cleanser to remove crusting or debris, especially if you have blepharitis.
• Humidifier Use: Adding moisture to the air can help relieve dry eyes and reduce reflex tearing.
• Allergen Avoidance: If allergies are the cause, minimize exposure to known allergens and consider using air purifiers.

Sources: American Academy of Ophthalmology (AAO), Cleveland Clinic, NIH.

Prevention Tips

While not all causes of excessive tearing can be prevented, the following tips can help reduce your risk:

• Protect Your Eyes: Wear sunglasses outdoors to shield your eyes from wind, dust, and UV rays.
• Practice Good Eye Hygiene: Avoid rubbing your eyes, and wash your hands frequently to prevent infections.
• Stay Hydrated: Drinking plenty of water helps maintain healthy tear production and prevents dryness.
• Manage Allergies: Work with your doctor to identify and avoid allergens, and use medications as prescribed.
• Take Breaks from Screens: Follow the 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds) to reduce eye strain and dryness.
• Use Artificial Tears: If you’re prone to dry eyes, use preservative-free lubricating drops to keep your eyes moist.
• Quit Smoking: Smoking can irritate the eyes and worsen dryness or tearing.

Emergency Warning Signs

Seek immediate medical attention if you experience any of the following symptoms alongside excessive tearing:

• Sudden vision loss or severe vision changes.
• Intense eye pain or headache.
• Signs of an eye infection, such as severe redness, pus-like discharge, or swelling that worsens rapidly.
• Trauma to the eye, such as a puncture, deep scratch, or chemical burn.
• Symptoms of a stroke or neurological issue, such as facial drooping, slurred speech, or weakness on one side of the body (if tearing is accompanied by these, it could indicate a serious condition like Bell’s palsy or a stroke).
• High fever or signs of systemic infection (e.g., chills, body aches).

These symptoms may indicate a medical emergency that requires prompt evaluation and treatment.

Excessive tearing can be bothersome, but with the right diagnosis and treatment, most cases can be effectively managed. If you’re concerned about your symptoms, don’t hesitate to reach out to a healthcare professional for guidance.