Tearing (Eye): Causes, Symptoms, and Treatment

What is Tearing (Eye)?

Tearing, or epiphora, refers to an overflow of tears onto the face, often without an apparent reason. While tears are essential for maintaining eye health by lubricating the surface and washing away debris, excessive tearing can be bothersome and may indicate an underlying issue. The condition can affect one or both eyes and may occur intermittently or constantly.

According to the Mayo Clinic, tears are produced by the lacrimal glands located above each eye. They drain through small openings (puncta) on the inner corners of the eyelids into the lacrimal sac and then into the nasal cavity. Any disruption in this drainage system or overproduction of tears can lead to excessive tearing.

Common Causes

Excessive tearing can result from various conditions affecting the eye or its surrounding structures. Here are some common causes:

• Dry Eye Syndrome: Paradoxically, dry eyes can lead to excessive tearing. When the eyes are too dry, the lacrimal glands may overproduce tears to compensate. This is a common condition, especially in older adults (National Eye Institute).
• Blocked Tear Ducts: A blockage in the tear drainage system can cause tears to overflow. This is common in infants but can also occur in adults due to infections, injuries, or tumors (American Academy of Ophthalmology).
• Eye Infections: Conditions like conjunctivitis (pink eye) or blepharitis (eyelid inflammation) can cause irritation and excessive tearing. Bacterial or viral infections are often to blame (CDC).
• Allergies: Allergic reactions to pollen, dust, pet dander, or other allergens can lead to itchy, watery eyes. This is often accompanied by other symptoms like sneezing or a runny nose (American College of Allergy, Asthma & Immunology).
• Foreign Objects or Irritants: Dust, sand, or even an eyelash in the eye can cause irritation and tearing. Chemical irritants like smoke or fumes can also trigger excessive tearing.
• Eyelid Problems: Conditions like ectropion (outward turning of the eyelid) or entropion (inward turning of the eyelid) can disrupt the normal tear film and drainage, leading to tearing (Cleveland Clinic).
• Corneal Abrasions or Ulcers: Scratches or infections on the cornea can cause significant pain, redness, and tearing. These require prompt medical attention to prevent complications.
• Blepharospasm: This condition involves involuntary spasms of the eyelid muscles, which can lead to excessive blinking and tearing. It may be associated with neurological conditions.
• Sinuses or Nasal Passages Issues: Since the tear drainage system connects to the nasal cavity, conditions like sinus infections or nasal polyps can cause blockages and lead to tearing.
• Medications: Certain medications, such as chemotherapy drugs, epinephrine, or eye drops (especially those containing preservatives), can cause excessive tearing as a side effect.

Associated Symptoms

Excessive tearing is often accompanied by other symptoms that can help identify the underlying cause. These may include:

• Redness or swelling of the eye or eyelid
• Pain or discomfort in or around the eye
• Itching or burning sensation
• Blurred or decreased vision
• Sensitivity to light (photophobia)
• Discharge from the eye (clear, white, yellow, or green)
• Crusting of the eyelids or lashes, especially upon waking
• Foreign body sensation (feeling like something is in the eye)
• Nasal congestion or runny nose (if allergies or sinus issues are involved)

If you experience any of these symptoms along with excessive tearing, it’s important to note their duration and severity, as this information can help your healthcare provider determine the cause.

When to See a Doctor

While occasional tearing is usually not a cause for concern, you should seek medical attention if you experience any of the following:

• Tearing that persists for more than a few days without improvement
• Pain in or around the eye
• Vision changes, such as blurred or double vision
• Significant redness or swelling of the eye or eyelid
• Discharge from the eye, especially if it is thick, yellow, or green (indicating a possible infection)
• Tearing accompanied by a headache, fever, or other systemic symptoms
• Injury to the eye or exposure to chemicals
• Tearing in an infant, which may indicate a blocked tear duct or other congenital issue

If you wear contact lenses and experience excessive tearing, remove the lenses and consult your eye care provider, as this could indicate an infection or other complication.

Diagnosis

To diagnose the cause of excessive tearing, your healthcare provider will likely begin with a thorough medical history and eye examination. Here’s what you can expect during the diagnostic process:

• Medical History: Your doctor will ask about your symptoms, including when the tearing started, whether it affects one or both eyes, and any associated symptoms. They may also ask about your overall health, medications, and any recent injuries or exposures.
• Eye Examination: A comprehensive eye exam will include:
  • Visual acuity test to check your vision
  • Slit-lamp examination to inspect the structures of the eye, including the cornea, conjunctiva, and eyelids
  • Evaluation of tear production and drainage
  • Assessment of eyelid position and function
• Specialized Tests: Depending on the suspected cause, additional tests may be performed:
  • Fluorescein Dye Test: A dye is placed in the eye to check for corneal abrasions or ulcers under a special light.
  • Tear Drainage Test: This involves flushing a saline solution through the tear drainage system to check for blockages.
  • Imaging Tests: In some cases, imaging such as a CT scan or MRI may be ordered to evaluate the nasal passages or lacrimal system for structural issues.
  • Allergy Testing: If allergies are suspected, your doctor may recommend skin or blood tests to identify specific allergens.

Based on the findings, your doctor may refer you to an ophthalmologist (eye specialist) or another specialist for further evaluation and treatment.

Treatment Options

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

Medical Treatments

• Antibiotics: If a bacterial infection is causing the tearing, antibiotic eye drops or ointments may be prescribed. Oral antibiotics may be necessary for more severe infections.
• Antihistamines or Mast Cell Stabilizers: For tearing caused by allergies, antihistamine eye drops (e.g., ketotifen) or oral medications (e.g., loratadine) can help reduce symptoms.
• Anti-inflammatory Medications: Steroid eye drops may be used to reduce inflammation in conditions like uveitis or severe allergic reactions.
• Artificial Tears: Lubricating eye drops can help if dry eye syndrome is the cause of excessive tearing. Preservative-free options are often recommended for frequent use.
• Punctal Plugs: Small plugs can be inserted into the tear ducts to block drainage and keep tears on the eye surface longer. This is often used for dry eye syndrome.
• Surgery: Surgical intervention may be necessary for conditions like blocked tear ducts, ectropion, or entropion. Procedures can range from minor outpatient surgeries to more complex reconstructions.

Home Remedies and Lifestyle Changes

• Warm Compresses: Applying a warm, damp cloth to the eyes can help relieve symptoms of blepharitis or blocked tear ducts by loosening debris and improving drainage.
• Eyelid Hygiene: Gently cleaning the eyelids with a mild solution (e.g., diluted baby shampoo) can help manage blepharitis and reduce irritation.
• Avoiding Irritants: If allergies or environmental irritants are the cause, try to avoid exposure to known triggers. Using air purifiers and wearing sunglasses outdoors can help.
• Humidifiers: Adding moisture to the air with a humidifier can help alleviate dry eye symptoms, especially in dry or windy climates.
• Proper Contact Lens Care: If you wear contact lenses, ensure you follow proper hygiene practices, such as cleaning and storing them correctly and avoiding overuse.

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 or protective goggles to shield your eyes from wind, dust, and UV rays, especially in outdoor or hazardous environments.
• Manage Allergies: If you have known allergies, work with your healthcare provider to manage them effectively with medications or avoidance strategies.
• Practice Good Eye Hygiene: Regularly clean your eyelids and avoid touching or rubbing your eyes with dirty hands to prevent infections.
• Stay Hydrated: Drinking plenty of water can help maintain adequate tear production and prevent dry eyes.
• Take Breaks from Screens: Follow the 20-20-20 rule to reduce eye strain: every 20 minutes, look at something 20 feet away for 20 seconds.
• Use Artificial Tears: If you are prone to dry eyes, using lubricating eye drops can help maintain moisture and prevent overproduction of tears.
• Quit Smoking: Smoking can irritate the eyes and worsen conditions like dry eye syndrome. Avoiding smoke and other irritants can improve eye health.

Emergency Warning Signs

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

• Severe Eye Pain: Intense pain could indicate a corneal abrasion, ulcer, or glaucoma, all of which require urgent care.
• Sudden Vision Loss or Changes: Any sudden change in vision, such as blurred vision, double vision, or loss of vision, is a medical emergency.
• Eye Injury: If you have sustained an injury to the eye, especially from a foreign object, chemical exposure, or trauma, seek help immediately.
• Signs of Infection: Symptoms like severe redness, swelling, pus-like discharge, or fever may indicate a serious infection that needs prompt treatment.
• Headache with Nausea or Vomiting: These symptoms, combined with eye pain and tearing, could indicate acute glaucoma, a condition that requires emergency treatment to prevent permanent vision loss.
• Proptosis (Bulging Eye): If your eye appears to bulge outward, this could be a sign of a serious condition like thyroid eye disease or an orbital infection.

If you experience any of these emergency symptoms, do not wait—go to the nearest emergency room or contact your healthcare provider immediately.

Conclusion

Excessive tearing can be a minor annoyance or a sign of a more serious underlying condition. Understanding the potential causes, associated symptoms, and when to seek medical attention is crucial for maintaining eye health. If you experience persistent or concerning symptoms, don’t hesitate to consult a healthcare provider for a thorough evaluation and appropriate treatment.

For more information on eye health, visit reputable sources like the National Eye Institute, American Academy of Ophthalmology, or World Health Organization.