Epiphora Causes and Treatments

Picture of one eye with a tear streaming down the cheek.

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Excessive tearing, otherwise known as epiphora, occurs when the eye produces too many tears or doesn’t adequately drain the tears. You perpetually have tears on the surface of your eyes. It’s only when these become excessive and you start to notice them that it can cause problems.

Tearing occurs when these pool in the eyes and sometimes spill over onto the cheeks—akin to crying but without sadness. Tearing, in this case, is a symptom of an underlying issue. If you treat that cause, the tearing should stop.

In some cases, though, there may actually be more than one factor at play. Look for all the factors that may be contributing here, including colds, allergies, a blocked tear duct, and more.

Colds

A simple head cold can bring on tearing when white blood cells inflame the eye’s mucous membranes. This can cause the tear ducts to clog. The tears build up, and the eyes start to water.

You may also experience a runny nose, sneezing, sore throat, body aches, and fever. In some cases, the cold virus may cause conjunctivitis with eye symptoms such as swelling, itching, redness, discharge, and foreign body sensation.

Treatment

Using over-the-counter antihistamines can help dry up secretions and tamp down on watery eyes until the cold has had the chance to run its course.

Allergies

If you have watery eyes that are also burning, red, and itchy, the culprit may be seasonal allergies. It all starts when an allergen hits the transparent membrane surface of the eye and inside the eyelids, known as the conjunctiva. This has a lot of immune cells on it that can react and release histamine proteins.

This can start a reaction in which the eye produces a lot of tears in response to the allergen.

Treatment

Staving off eye allergy can begin with prevention. This may mean staying inside with windows closed and air conditioning on when pollen levels are high.

You may also want to install high-efficiency particulate air (HEPA) filters to keep allergen levels as low as possible. Applying cool compresses can provide some relief as well.

Some medications that may help include the following:

  • Soothe eyes with artificial tears.
  • Use over-the-counter antihistamines to help block the production of histamine proteins at the heart of the allergic reaction.
  • Get prescription nonsteroidal anti-inflammatory or mast cell stabilizer drops to quell the allergic reaction and accompanying tearing.
  • Apply potent corticosteroid drops to quash an allergic reaction. Keep in mind that these have side effects, such as a risk of developing glaucoma and cataracts, so careful follow-up is needed.

Blocked Tear Duct

If a duct becomes blocked or narrows, as can often happen with age, this doesn’t allow tears to drain properly. Other causes of tear drainage constriction can include infection, area trauma, surgery, inflammatory disorders.

In some cases, the cause of the blocked tear duct may not be known. It may result from other health problems such as chronic nasal infections, conjunctivitis, nose polyps, or a tumor obstructing the area.

Treatment

Measures such as applying warm compresses, massaging the eye, or using antibiotics to treat an infection may open the clogged tear duct, or you may be advised to undergo a procedure to help dilate the nasolacrimal duct. If something like a tumor is blocking the area, it may be necessary to remove it.

A surgical procedure known as a dacryocystorhinostomy may be performed to create a drainage path if none of these approaches work.

Infection

Certain eye infections can lead to excessive tearing. Anyone with pink eye (conjunctivitis) may find themselves with extremely watery, red, irritated eyes. Since a virus usually causes this, antibiotics are ineffective. The use of cold compresses to soothe the eye and frequent hand washing to prevent spread are generally recommended.

Also, those who have styes (bumps on the eyelid) may find that their eyes are irritated and prone to watering. These usually develop when an oil gland gets clogged. Styes respond to warm compresses that help to liquefy and release the oil inside.

Inflammation

If you have inflammation of the eyelids (blepharitis), your eyes may become red, irritated, crusty, and excessively teary. One way to deal with this is to mix water and baby shampoo and use this to clean your lids gently. You can buy a similar product over the counter.

Warm compresses may help, as well as massaging the eyelids if the glands are blocked. You should also avoid wearing any eye makeup for the time being and wear glasses instead of contact lenses.

Reflex Tearing

If the nerves on the eye’s surface sense dryness, the result may be reflex tearing and, ironically, very watery eyes. That’s because to compensate, the eye may produce an over-abundance of tears. However, these tears aren’t the right type and don’t remain on the surface long enough to get to the root of the underlying dry eye problem.

Eyelid Malposition

The eyelid itself may be a cause of excessive tearing. When the lid is malpositioned, it does not allow for proper tear drainage when blinking.

With age, the eyelid may become droopy and gap away from the eye. This is what’s known as ectropion.

If the eyelid turns inward, this is known as entropion. This usually occurs when muscles and tendons stretch out with age and turn inward.

Besides aging, other factors that can lead to eyelid malposition include:

  • A tumor or lump
  • Area skin injury from a burn, allergic condition, or prior surgery
  • Nerve problems involving eyelid control
  • A congenital issue

Treatment for eyelid malposition issues can include:

  • Using eye drops to lubricate the eye
  • Applying steroid ointment
  • Using tape to close the lids at night when there is a risk of exposure
  • Using a piece of tape vertically on the cheek to pull the lower lid down so that it doesn’t turn inward
  • Having the excessive skin surgically removed

Injury

If the eye becomes injured, this can also lead to tearing issues. A scratch on the protective cornea of the eye can lead to complaints of increased tearing. Fortunately, this type of injury usually heals quickly but needs to be monitored since it can easily become infected.

Also, chemical agents that accidentally get in the eye may cause excessive tearing. They should be immediately flushed from the eye with cool water to help minimize any damage. Some may be only minor irritants, while others can be far more serious.

After immediately flushing the eye, go to the emergency room to ensure there is no lasting damage.

Medication

The medications you take may also be the cause of watery eyes. In many cases, such medications increase the risk of dry eye, which can then lead to excessive tearing. These include:

  • Antihistamines
  • Antidepressants
  • Some types of blood pressure medication
  • Birth control pills

In addition, there have been reports of the use of the agent docetaxel for treating breast cancer and other types of cancer as leading to teary eyes. This is particularly true at higher doses. The good news is that in all cases, this was reversible and tended to be mild.

Summary

Epiphora (excessive tearing) can occur due to a variety of causes. Colds, allergies, a blocked tear duct, infection, inflammation, injury, or dry eye syndrome may be the culprit. The treatment will depend on the underlying cause.

A Word From Verywell

In most cases, if you address the underlying issue, the epiphora will resolve. However, if this does not improve or worsens, be sure to bring this to your doctor’s attention immediately.

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17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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