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Tearing (Epiphora)

What is Tearing (epiphora)?

Epiphora, commonly called excessive tearing, is the abnormal overflow of tears onto the cheek or lower eyelid. Tears are produced by the lacrimal glands to keep the eye surface moist, clear away debris, and provide antimicrobial protection. Under normal conditions, tear fluid drains through a small canaliculi system into the lacrimal sac and then into the nasal cavity. When production exceeds drainage, tears spill over the lid margin—this visible overflow is what clinicians refer to as epiphora.<sup>1</sup>

Epiphora can be continuous (present all day) or intermittent (only with certain activities such as crying, wind, or reading). It may affect one eye, both eyes, or alternate depending on the underlying cause. While often benign, persistent tearing can impair vision, cause skin irritation, and be socially distressing, making proper evaluation important.

Common Causes

Most cases of epiphora fall into two broad categories: over‑production of tears or obstruction of normal tear drainage. Below are the most frequently encountered conditions (in alphabetical order).

• Allergic conjunctivitis – Histamine‑mediated inflammation of the conjunctiva leads to watery discharge.
• Blepharitis – Inflammation of the eyelid margin; crusting can block the canaliculi.
• Conjunctival irritation – From smoke, wind, or chemicals, stimulating reflex tearing.
• Dacryocystitis – Infection of the lacrimal sac usually secondary to nasolacrimal duct blockage.
• Dry eye syndrome – Paradoxically, insufficient tear film triggers a compensatory excess tear production.
• Lacrimal duct obstruction – Congenital or acquired narrowing/closure of the nasolacrimal duct.
• Punctal stenosis – Scarring of the tiny puncta (tear‑drain openings) at the inner eyelid.
• Nasolacrimal duct tumors or polyps – Space‑occupying lesions obstruct flow.
• Parasympathetic overactivity – Certain medications (e.g., pilocarpine) or neurological conditions can boost tear secretion.
• Problems with eyelid position – Ectropion (out‑turning) or entropion (in‑turning) disrupts the normal “pump” action of blinking.

Associated Symptoms

Epiphora seldom appears in isolation. The following symptoms often accompany the tearing and can provide clues about the cause.

• Redness or pinkness of the conjunctiva
• Itching, burning, or gritty sensation
• Blurred vision that clears after blinking
• Discharge that is clear, mucoid, or purulent (suggesting infection)
• Swelling around the inner corner of the eye (medial canthus)
• Crusting or flakes on the eyelid margins
• Visible blockage of the puncta or canaliculi
• Pain or tenderness over the lacrimal sac (especially with dacryocystitis)
• Eye fatigue after reading or computer use

When to See a Doctor

Most mild cases of epiphora can be managed with home care, but you should schedule a clinic visit promptly if you notice any of the following:

• Persistent tearing for more than two weeks without improvement
• Pain, swelling, or redness around the inner eye corner
• Yellow or green discharge (possible infection)
• Sudden onset of tearing after head or eye trauma
• Blurred vision that does not clear with blinking
• History of eye surgery, facial fractures, or tumors
• Associated systemic symptoms such as fever, facial pain, or sinus congestion

Diagnosis

Eye care professionals (optometrists, ophthalmologists) use a step‑wise approach:

1. Medical history – Onset, duration, triggers, medications, allergies, prior eye surgeries.
2. Visual acuity test – Rules out vision problems that mimic tearing.
3. Slit‑lamp examination – Magnified view of the eyelids, conjunctiva, cornea, and tear film to detect inflammation, foreign bodies, or punctal narrowing.
4. Dye disappearance test (fluorescein or rose bengal) – Drops a colored solution on the eye; the time it clears indicates drainage efficiency.
5. Nasolacrimal duct probing and irrigation – A thin probe or saline flush assesses patency; resistance suggests obstruction.
6. Imaging (CT or MRI) – Ordered when a tumor, sinus disease, or complex facial trauma is suspected.
7. Allergy testing – If allergic conjunctivitis is a leading possibility.

Treatment Options

Treatment is tailored to the underlying cause and severity.

Medical (pharmacologic) treatments

• Artificial tears – Preservative‑free lubricants help dry‑eye‑related reflex tearing.
• Antihistamine or mast‑cell stabilizer eye drops – For allergic conjunctivitis (e.g., olopatadine, ketotifen).
• Topical antibiotics or steroid‑antibiotic combos – Used for bacterial conjunctivitis or dacryocystitis after culture.
• Systemic antihistamines – Helpful if allergic rhinitis contributes to tearing.
• Oral doxycycline – Occasionally used for chronic blepharitis or meibomian gland dysfunction.

Surgical / procedural interventions

• Punctal dilation or dilation with a punctal plug – Opens or temporarily blocks the puncta to regulate flow.
• Laser or radiofrequency punctoplasty – Reshapes scarred puncta to improve drainage.
• Nasolacrimal duct intubation (stent placement) – A tiny silicone tube maintains duct openness, often used after probing.
• Dacryocystorhinostomy (DCR) – Creating a new drainage pathway between the lacrimal sac and nasal cavity; performed endoscopically or externally for chronic obstruction.
• Eyelid surgery – Corrects ectropion or entropion that interferes with the lid pump mechanism.

Home & lifestyle measures

• Warm compresses (5–10 minutes, 2–3 times daily) to melt meibomian gland secretions.
• Gentle lid hygiene – cotton swab with diluted baby shampoo to clear debris.
• Avoid eye‑irritating environments (smoke, strong wind, chlorine).
• Use humidifiers in dry indoor settings.
• Wear protective goggles during sports or occupational exposure.

Prevention Tips

While not all causes are preventable, several strategies reduce the risk of developing epiphora or worsening existing tearing.

• Manage allergies early – Daily antihistamine eye drops in pollen season.
• Maintain eyelid health – Clean eyelid margins each night; treat blepharitis promptly.
• Protect against trauma – Use safety glasses during construction, gardening, or high‑impact sports.
• Stay hydrated and use lubricating drops – Helps keep the tear film stable, especially in dry climates or prolonged screen time.
• Regular eye examinations – Detect subtle drainage problems before they become symptomatic.
• Avoid over‑use of eye makeup – Remove cosmetics before sleep to prevent canalicular blockage.

Emergency Warning Signs

Key Take‑aways

Epiphora is a common but often treatable symptom. Understanding whether the problem stems from excess tear production or a drainage blockage guides effective therapy. Simple home measures—lid hygiene, allergy control, and protective eyewear—help many people, while persistent or painful cases warrant professional evaluation to rule out infection, structural obstruction, or more serious ocular disease.

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References:

1. Mayo Clinic. “Epiphora (excessive tearing).” Accessed March 2024.
2. American Academy of Ophthalmology. “Dry Eye Disease.” 2023.
3. National Eye Institute (NEI). “Lacrimal System Anatomy.” 2022.
4. Cleveland Clinic. “Blepharitis.” Updated 2023.
5. World Health Organization. “Global Burden of Allergic Eye Disease.” 2021.

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