Excessive Tearing (Epiphora)

What is Tearing (excessive)?

Excessive tearing, medically known as epiphora, is the production of more tears than the eye can drain away. Tears are essential for keeping the ocular surface moist, providing nutrients, and washing away debris. In normal conditions, a balanced amount of tears is produced and drains through the tiny puncta (openings on the eyelid margins) into the nasolacrimal drainage system. When this balance is disrupted—either because the eye makes too many tears or the drainage pathway is blocked—tears overflow onto the cheeks, causing a watery, often uncomfortable, appearance.

While occasional tearing is common (e.g., after cutting onions or during strong emotions), chronic or intermittent excessive tearing can affect vision, cause skin irritation, and be socially distressing. Understanding the underlying cause is key to effective treatment.

Common Causes

Excessive tearing can stem from problems in three main areas: tear production, tear drainage, and surface irritation. Below are the most frequent conditions that lead to epiphora.

• Dry Eye Syndrome (aqueous-deficient or evaporative) – Paradoxically, a dry ocular surface can trigger reflex tearing.
• Allergic Conjunctivitis – Pollen, pet dander, or mold cause inflammation and watery discharge.
• Blepharitis – Inflammation of the eyelid margin can alter tear film stability.
• Blocked Nasolacrimal Duct (NLDO) – Congestion or scarring prevents tears from draining.
• Conjunctivitis (viral or bacterial) – Infection leads to increased tear production and discharge.
• Ectropion or Entropion – Improper eyelid positioning disrupts tear flow.
• Nasolacrimal Duct Tumor or Nasal Polyps – Masses compress the drainage pathway.
• Foreign Body or Corneal Abrasion – Mechanical irritation stimulates reflex tearing.
• Medication side‑effects – Drugs such as antihistamines, isotretinoin, or certain glaucoma drops can affect tear dynamics.
• Neurologic conditions – Trigeminal nerve lesions or facial palsy can alter lacrimal gland stimulation.

Associated Symptoms

Depending on the cause, excessive tearing is often accompanied by other ocular or systemic signs:

• Eye redness or bloodshot appearance
• Itching, burning, or gritty sensation
• Sticky or mucous‑laden discharge
• Swelling of eyelids or surrounding skin
• Blurred vision that improves after blinking
• Sensitivity to light (photophobia)
• Pain or pressure around the eye or nose
• History of allergies, sinus infections, or recent upper‑respiratory illness

When to See a Doctor

Most cases of mild tearing can be observed at home, but seek professional evaluation if you notice any of the following:

• Persistent tearing lasting more than two weeks without obvious trigger
• Accompanying pain, redness, or swelling that worsens
• Discharge that is thick, yellow/green, or foul‑smelling (possible infection)
• Blurred vision that does not clear with blinking
• History of recent eye injury, surgery, or contact‑lens complications
• Recurrent episodes that interfere with daily activities or work

Diagnosis

Eye care professionals use a systematic approach to pinpoint the cause of epiphora.

History

Questions focus on the onset, duration, triggers (e.g., allergies, wind, screen use), medication use, previous eye surgeries, and systemic illnesses.

Physical Examination

• External inspection – evaluate eyelid position, skin condition, and presence of crusting.
• Slit‑lamp exam – magnified view of the conjunctiva, cornea, and tear film.
• Fluorescein staining – highlights corneal abrasions or dry‑spot patterns.
• Dye disappearance test – assesses drainage by observing how quickly a fluorescein dye clears from the tear meniscus.
• Nasolacrimal duct probing or syringing – checks for blockage by flushing saline through the duct.
• Allergy testing – skin prick or serum IgE when allergic conjunctivitis is suspected.

Imaging (when needed)

• CT or MRI of the orbit/nasal cavity for suspected masses or sinus disease.
• Ultrasound biomicroscopy to view the puncta and canaliculi.

Treatment Options

Therapy targets the underlying cause and may combine medical, surgical, and lifestyle measures.

Medical Treatments

• Artificial tears or lubricating ointments – for dry‑eye‑related reflex tearing (use preservative‑free drops).
• Antihistamine or mast‑cell stabilizer eye drops – relieve allergic conjunctivitis (e.g., olopatadine).
• Topical antibiotics or antivirals – treat bacterial or viral conjunctivitis when indicated.
• Corticosteroid eye drops – short‑term use for severe inflammation; must be prescribed.
• Oral antihistamines or decongestants – helpful when systemic allergy symptoms coexist.
• Lacrimal gland botulinum toxin injections – reduce tear production in refractory cases.

Surgical & Interventional Options

• Nasolacrimal duct probing or intubation – first‑line for congenital or acquired blockage.
• Dacryocystorhinostomy (DCR) – creates a new drainage pathway; performed endoscopically or externally.
• Eyelid reconstruction – corrects ectropion, entropion, or ptosis that impair tear flow.
• Punctal plugs – small silicone devices placed in the puncta to block excess drainage in dry‑eye patients.

Home & Lifestyle Measures

• Warm compresses (5–10 minutes, 2–3 times daily) to improve meibomian gland function.
• Gentle eyelid hygiene – use a dilute baby‑shampoo solution or commercial lid scrub.
• Avoid irritants: smoke, strong fragrances, and windy environments.
• Stay hydrated; ensure indoor humidity is 40‑60 % to reduce evaporative dryness.
• Take scheduled breaks during prolonged screen time (20‑20‑20 rule).

Prevention Tips

While some causes (e.g., congenital NLDO) cannot be avoided, many triggers are modifiable.

• Manage allergies – keep windows closed during high pollen counts, use HEPA filters, and follow prescribed allergy meds.
• Maintain lid hygiene – especially for people with blepharitis or rosacea.
• Protect eyes from wind and debris – wear sunglasses or protective goggles.
• Limit contact lens wear time – replace lenses as recommended and practice proper cleaning.
• Regular eye examinations – early detection of nasolacrimal obstruction or eyelid malposition.
• Stay up‑to‑date on vaccinations – particularly flu and COVID‑19, which can reduce viral conjunctivitis risk.

Emergency Warning Signs

Key Takeaways

Excessive tearing is usually a symptom of an underlying ocular surface or drainage problem rather than a disease itself. A thorough eye examination, often complemented by simple diagnostic tests, can usually identify the cause. Most cases respond well to medical therapy (e.g., lubricants, allergy drops) or minimally invasive procedures (e.g., duct probing). However, persistent or painful tearing warrants prompt professional evaluation to prevent complications such as infection, corneal damage, or chronic skin irritation.

References

• Mayo Clinic. “Epiphora (excessive tearing).” https://www.mayoclinic.org
• Cleveland Clinic. “What Causes Excessive Tearing?” https://my.clevelandclinic.org
• American Academy of Ophthalmology. “Dry Eye.” https://www.aao.org
• National Eye Institute (NIH). “Allergic Conjunctivitis.” https://www.nei.nih.gov
• CDC. “Allergy Symptoms & Management.” https://www.cdc.gov
• World Health Organization. “Guidelines for the Management of Eye Infections.” https://www.who.int