What Are Watery Eyes?

When the tears won’t stop flowing, the cause isn’t always emotional. Tears are the fluid that helps maintain the eye. Problems with this system can cause your eyes to water without any apparent reason.

If you have watery eyes—also known as excessive eye watering, or epiphora—the problem is usually either overproduction or underdrainage of tears. Environmental factors, dry eyes, and allergies can also result in watery eyes. More seriously, an infection can be the reason why your eyes won't stop tearing up.

This article will help you learn more about these and other causes of watery eyes, as well as how to diagnose and treat this condition if it affects you.

How Do Tears Work?

The eyes' tear system is controlled by what are called lacrimal glands. These glands—one for each eye—are located on the outer edge of the upper eye, beneath the eyelid.

The lacrimal glands produce tears, a salty fluid that lubricates the eye with each blink. Normally, these glands make about 1.2 microliters of tears every minute, with the eyelids spreading the tear fluid evenly over the surface of the eye with each blink.

The moisture from tears helps prevent damage to the cornea, the outer covering of the eyeball, which can become inflamed or irritated if it's dry.

Up to 20% of the tears the eye makes evaporate. The orbicularis muscle pumps the remainder into the lacrimal puncta, the pouch-like bulge at the inner corner of the eye.

From the puncta, excess tears flow through the lacrimal ducts to the nasolacrimal duct and out the nasal cavity. This system has a capacity of 8 microliters. That's why too much tear production or insufficient drainage can result in watery eyes.

Symptoms of Watery Eyes

The primary sign of epiphora is eyes that water excessively. A number of other symptoms can also occur, including:

• Sharp pain
• Dry eyes
• Eyelid swelling
• Redness
• Itching
• Irritation
• Soreness
• Blurry vision
• Light sensitivity

If watery eyes are caused by allergies, symptoms will also include itchy eyes, runny nose, and sneezing.

What Causes Watery Eyes?

Problems that cause watery eyes fall into three categories:

• Too much tear production
• A problem with the composition of tears
• Poor drainage of excess tears

A host of problems can lead to watery eyes in these categories. Your healthcare provider will need to examine the surface of your eye and its duct system to pinpoint the origin of the issue.

Obstruction

Your tears flow through a system of tubes and ducts that carry excess tears away from your eyes. When any part of this system becomes blocked or plugged, tears can't drain properly, leading to a buildup and watery eyes. Blockages can occur in the eye itself, in the puncta, or in the lower drainage system.

Blockages in the tear duct can lead to an infection called dacryocystitis. Conditions like sarcoidosis, lymphoma, and conjunctivitis (pink eye) can also cause blockage. Age-related changes like narrowing of the punctal openings are another possible cause.

Dry Eyes

Dryness, which is irritating to the eyes, can stimulate the eye to produce more tears. Dry eyes are a condition all on their own, called blepharitis.

However, dryness that leads to irritation and overproduction of tears can also be caused by allergies, infections, certain medications such as acne medications and birth control pills, or chronic health conditions like arthritis and diabetes. Smoking, windy or dry environments, and sunlight can also lead to dry eyes.

Tear Chemistry

In some cases, watery eyes can be caused by an imbalance in the chemistry of your tears or other substances that lubricate the eye. Oils that line the eyelids can be out of balance, causing problems in the formation of tear fluid.

Glands that make oils along your eyelid can produce too much oil or become blocked, preventing tears from reaching the drainage system and causing excessive eye watering.

Facial Nerve Dysfunction

A number of facial nerve branches run through the eyes and the face. When there is injury or damage to these nerves, as in cases of facial palsy, the pumps and mechanisms that move tears through the duct system can become weak. When the pumps fail to move excessive tears through the drainage system, they can accumulate in the eye and result in watery eyes.

Other Causes

Allergies like hay fever are another common cause of watery eyes.

Additional conditions that your healthcare provider may take into consideration when evaluating you for watery eyes include:

• Meibomian gland dysfunction
• Recurrent corneal erosion
• Epithelial basement membrane disease
• Incomplete eyelid closure
• Eyelid conditions like entropion and ectropion
• Sjogren's syndrome
• Other inflammatory eye conditions

Your healthcare provider should also investigate any medications you might be taking, since they could be contributing factors.

How Watery Eyes Are Diagnosed

The first step in diagnosing the cause of watery eyes is collecting a thorough history and conducting an eye exam. Aside from visually examining your eye, your optometrist or ophthalmologist will also want to know about:

• Medications you take
• Any injuries that may have impacted your eyes
• Chronic diseases
• Allergies
• Environmental exposures to chemicals or other irritants

Your healthcare provider may perform several tests to determine the cause of your symptoms.

Tear Break-Up Time Test

This test analyzes the quality of the tear film covering the eye. If tears disappear—or “break up”—too quickly, the cornea is left unprotected, which can lead to irritation and other problems. Reduced tear break-up time can be a sign of dry eye syndrome (keratoconjunctivitis sicca), mucin deficiency, or Meibomian gland disease.

Dye Disappearance Test

For this test, your healthcare provider will drop a body-safe dye into the corner of your eye. Do not wipe it away or touch your eye. After five minutes, the dye should be cleared from the eye. If dye remains, this will indicate a possible blockage somewhere in the drainage system.

Observing patterns of dye movement and how well the dye drains—checked by swabbing the inside of the nose—can give your healthcare provider additional information about the drainage of tears from your eyes.

Lacrimal Drainage System Irrigation

For this test, a small syringe tip is gently inserted into the punctum at the corner of the eye. The tip will move easily into the punctum if there is no obstruction. While the test is invasive, your healthcare provider will use a topical anesthesia for comfort.

Next, saline or water is pushed through the syringe. The fluid should flow to the nose or throat without disruption. If the fluid doesn't flow through the drainage system freely, or if the fluid backs up, this is a sign of a blockage or obstruction somewhere. If drainage or mucus comes out with the fluid, this is an indication that part of the drainage system may be infected.

Treatment of Watery Eyes

Treatment for watery eyes focuses on resolving the underlying cause.

• Allergies or other irritants: If the trigger for your watery eyes is an allergy or environmental irritant, antihistamines or improving the air quality around you may help.
• Chronic conditions: In some cases, chronic diseases like Sjogren's syndrome are to blame. This disease in particular impacts how the body creates moisture. Treating chronic diseases like this can help alleviate the symptoms, like dry eyes, that come with it.
• Obstruction or infection: If an obstruction or infection is the cause of your watery eyes, your healthcare provider may be able to perform a procedure to clear the blockage by gently inserting a small instrument through the punctum, like during the lacrimal drainage irrigation test. If an infection is present, your healthcare provider will prescribe antibiotics.
• Ectropion or entropion: These conditions can lead to problems with tear function and production. In ectropion, the lower eyelid turns outward; in entropion, the eyelid turns inward. They can be treated with surgery, which has a high success rate.
• Tear production problems: If an imbalance in tear production or chemistry is creating watery eyes, punctal plugs may help. These are inserted into the punctal glands to reduce drainage of tears from the eye. Plugs made of collagen are temporary and will dissolve over time; plugs made of silicone or acrylic are meant to be semi-permanent. They can be inserted with local anesthesia in an office procedure and do not usually require recovery time.
  

In severe cases, surgery may be required to clear large obstructions or even rebuild the lacrimal drainage system. This procedure, called dacryocystorhinostomy, is done under general anesthesia. A surgeon will make an incision near the nose and create a new drainage system. A small tube will be inserted and left in place for several months as the surgical area heals.

In some cases, no cause is ever found, and you could be left with a condition known as functional epiphora. There are treatments that may help, such as Botox injections and surgery. However, the success rate of these treatments varies.

Coping with Watery Eyes

There are a number of steps you can take to help relieve watery eyes. Try these tips:

• Eye drops may help soothe irritated eyes and relieve the dryness that leads to watery eyes. Choose lubricating products rather than solutions that are marketed for reducing red eye, which can cause irritation.
• If your watery eyes are caused by allergies, reduce your exposure to allergens. When pollen counts are high, stay indoors as much as possible, close the windows, and run the air conditioner. Other steps that may help: keeping a pet out of certain areas of the house, installing high-efficiency air filters in your home, and removing household items that collect dust.
• For blockages, your healthcare provider may recommend a warm compress. A warm, wet, clean washcloth applied to the eyes for several minutes a few times a day can help open up blocked glands and let any fluid inside drain. 

Summary

Watery eyes can be caused by an obstruction of the tear duct, problems with tear production, allergies, chronic illnesses, and more. Treatment is often successful once your healthcare provider identifies the cause, which may involve medications, procedures, or surgery in some cases.