Experiencing continuously watery eyes, known medically as epiphora, can be more than just an annoyance. It can interfere with daily life, making tasks like reading, driving, or simply being outdoors uncomfortable. While occasional tearing is normal, persistent, excessive watering can signal an underlying issue that requires specialist evaluation.
At Haringey Hospital in North London, our consultants offer detailed diagnostic and tailored treatment pathways for epiphora, ensuring you receive the precise care required to restore comfort and clarity to your vision.
What Causes Watering Eyes (Epiphora)?
Epiphora occurs when there is an imbalance between the production of tears and their drainage. Tears are vital for keeping the eyes lubricated and healthy, but when the system malfunctions, an overflow occurs.
The fundamental causes of watery eyes fall into two main categories:
- Overproduction of Tears (Hypersecretion)
The eyes may produce excessive tears as a reflex response to irritation or inflammation. Common triggers include:
- Environmental Irritants: Exposure to wind, smoke, dust, bright light, or dry air.
- Allergies: Reactions to pollen, pet dander, or dust mites, often leading to allergic conjunctivitis (inflammation of the conjunctiva).
- Foreign Body: A particle trapped on the surface of the eye.
- Infection: Conditions like blepharitis (inflammation of the eyelid margins) or bacterial/viral conjunctivitis.
- Corneal Irritation: A scratch or abrasion on the cornea (the clear, protective outer layer of the eye).
- Impaired Tear Drainage (Obstruction)
Normally, tears drain through tiny openings called puncta in the corner of the eyelids, flowing into the lacrimal drainage system (tear ducts) and down into the nose. If this drainage pathway is blocked or narrowed, tears pool and overflow. Causes of impaired drainage include:
- Stenosis (Narrowing) of the Puncta: The openings are too narrow to allow sufficient drainage.
- Blocked Tear Ducts (Nasolacrimal Duct Obstruction): This can be caused by inflammation, injury, or age-related changes.
- Ectropion or Entropion: The eyelid turning outwards (ectropion) or inwards (entropion), which positions the puncta away from the tear lake or causes irritation, respectively.
Who Does Epiphora Affect and Why?
Epiphora is a highly prevalent condition that affects people of all ages, though it is more common in specific groups.
Watery Eyes in Adults
The condition is frequently observed in middle-aged to older adults. This is primarily because the structures supporting the eyelids and the tear drainage system naturally weaken or narrow with age. This includes the weakening of the muscles that keep the puncta properly positioned against the eye surface.
MGD and the Mature Eye
Research consistently demonstrates that Meibomian Gland Dysfunction (MGD) is a frequent underlying cause of persistent eye discomfort and tearing, particularly in the mature eye. One study focusing on an older population found that nearly 60% of subjects had at least one abnormal MG parameter.
Critically, this research highlighted that abnormal meibum quality, found in over half of the subjects studied , was significantly associated with more severe dry eye symptoms, ocular pain, and poor tear film stability. This underscores why a comprehensive, specialist diagnosis is crucial—the condition causing your discomfort is extremely common and requires targeted expertise to manage effectively.
Watery Eyes in the Elderly
In the elderly, the most common specific causes are:
- Age-Related Stenosis: The tear ducts narrow over time, reducing their ability to drain tears effectively.
- Laxity of the Eyelids: The ligaments and skin surrounding the eyelids lose their elasticity, often leading to ectropion (an outward turning of the lower eyelid), which prevents the tear drainage openings from making proper contact with the eye.
Watery Eyes in Children
While less common, excessive tearing in infants is usually due to a congenital nasolacrimal duct obstruction, meaning the tear duct has not fully opened at birth. This often resolves naturally within the first year.
Recognising the Symptoms of Epiphora
While the most obvious symptom is tear overflow, a specialist will look for a range of indicators to determine the cause.
The main symptoms of persistent watery eyes include:
- Epiphora (Overflow): Tears continuously running down the cheek, even when not crying.
- Redness or Irritation: The skin around the eyes can become sore, red, or irritated due to constant moisture.
- Blurred Vision: The excess layer of moisture on the eye surface temporarily distorts vision.
- Crusting: Discharge and matter may accumulate around the eyelashes, particularly upon waking.
- Recurrent Eye Infections: Blocked tear ducts can create a stagnant pool of fluid, increasing the risk of infection.
Diagnosis and Treatment at Haringey Hospital
Understanding the precise cause is essential for effective treatment. Our consultants utilise advanced diagnostic techniques in a comfortable, private setting.
“One of the most common causes of eye problems we see here at Haringey Hospital comes from our lifestyles. Factors like toxins and pollutants along with allergies can be some of the most common causes of epiphora. Of course, there are many other health conditions that can also lead to eye problems, like diabetes for example. This is why it’s always important to make sure you always get any health concerns checked by a health care professional as soon as possible.” Dr Manvi Sobta
How is Epiphora Diagnosed?
A consultant ophthalmologist will conduct a thorough examination, which may include:
- Clinical Examination: Inspecting the eyelids, tear drainage points, and the surface of the eye for signs of inflammation, infection, or structural abnormalities (e.g., ectropion).
- Fluorescein Dye Test: A special orange dye is applied to the eye. The time it takes for the dye to disappear from the eye surface helps determine if the drainage is slow or blocked.
- Syringing and Probing: Saline solution is flushed through the tear ducts. If the patient tastes the saline, the system is partially or fully open; if it regurgitates, a blockage is confirmed.
- Imaging: In complex cases, specialised imaging techniques may be used to pinpoint the exact location and nature of a blockage.
How is Epiphora Treated?
Treatment pathways are highly individualised and depend entirely on the root cause identified during diagnosis:
- Overproduction (Irritation/Allergies): Addressing the underlying trigger. This may involve prescribing medicated eye drops to manage allergies or infections, lubricating eye drops for dry eye-induced tearing, or simply avoiding environmental irritants.
- Punctal Narrowing (Stenosis) Punctoplasty: A minor procedure, often performed under local anaesthetic, to surgically widen the small punctal opening to improve drainage.
- Blocked Tear Duct (Nasolacrimal Duct Obstruction): Dacryocystorhinostomy (DCR): A surgical procedure that creates a new, direct passage from the lacrimal sac into the nose, bypassing the blockage. This is often performed endoscopically (through the nose) to avoid external scarring.
- Eyelid Malposition (Ectropion/Entropion) Eyelid Surgery: A small corrective surgical procedure to reposition the eyelid and restore the correct relationship between the puncta and the eye surface.
Managing Symptoms and Reducing Risk
While seeking professional advice is essential, you can manage the discomfort and take steps to protect your eyes.
How Do I Manage Symptoms of Watery Eyes?
- Gentle Cleaning: Gently wipe away excess tears with a clean tissue, blotting rather than rubbing to prevent skin irritation.
- Avoid Irritants: Limit exposure to smoky environments, strong winds, and chemicals.
- Warm Compresses: If watery eyes are linked to blepharitis, regular warm compresses can help clear the oil glands along the eyelid margins.
- Protective Eyewear: Wear sunglasses or safety glasses outdoors to protect the eyes from wind and debris.
How Can I Reduce My Risk of Epiphora?
Most structural causes are age-related and unavoidable. However, maintaining excellent eye hygiene and taking a proactive approach can minimise the risk of inflammation-related epiphora:
- Manage Allergies: If you have known allergies, use prescribed or over-the-counter anti-allergy medication as directed.
- Treat Infections Promptly: Seek early treatment for any eye infection or eyelid inflammation.
- Regular Eye Examinations: Ensure you have regular check-ups with an ophthalmologist to detect and address early signs of dry eye disease, which paradoxically can cause reflex tearing.
When to Seek Specialist Care
What can I expect if I have epiphora?
If left untreated, epiphora can be chronic and significantly affect your quality of life. The constant tearing, blurred vision, and risk of recurrent infections necessitate specialist intervention. At Haringey Hospital, you can expect rapid access to consultation, precise diagnosis, and a comprehensive treatment plan delivered in a comfortable, discreet environment.
When should I see a doctor?
You should arrange a consultation with a specialist if:
- The watering is persistent and affects daily activities like driving or reading.
- It is accompanied by pain, redness, discharge, or changes in vision.
- The condition does not improve after a few weeks of general management (like warm compresses or avoiding wind).
What questions should I ask my doctor?
When you attend your consultation at Haringey Hospital, we encourage you to ask as many questions as you want, the following questions should always be covered:
- “Is my epiphora caused by overproduction of tears or a drainage issue?”
- “What specific diagnostic tests will be needed to confirm the cause?”
- “Based on the diagnosis, what is the most effective treatment for me—medical or surgical?”
- “What are the success rates and recovery times for the recommended procedure, such as DCR or punctoplasty?”
- “How will this treatment improve my overall vision and quality of life?”
To arrange a private consultation with one of our specialist ophthalmology consultants in North London, please contact the Haringey Hospital appointment team today.