Constantly wiping away tears can be far more than a minor inconvenience. Persistent Watery Eyes (Epiphora), known medically as epiphora, can interfere with reading, driving, working, and simply enjoying time outdoors. While occasional tearing is perfectly normal, continuous overflow often signals an underlying issue that requires specialist assessment. At Abbey Wood Hospital’s Ophthalmology department, our consultants provide expert diagnosis and tailored treatment pathways to restore comfort and clarity to your vision.
In This Article
Understanding why your eyes water excessively is the first step towards effective treatment. Think of the eye’s tear system like a domestic sink: watery eyes occur either because the tap is running too fast (overproduction of tears) or because the drainpipe is blocked, causing the basin to overflow (impaired drainage). Our specialist team can identify exactly what is happening and recommend the most appropriate solution.
What Causes Watery Eyes?
Epiphora occurs when there is an imbalance between tear production and drainage. According to NHS guidance on watering eyes, the condition typically falls into one of two categories.
Overproduction of Tears (Reflex Tearing)
The eyes may produce excessive tears as a protective response to irritation or inflammation. Ironically, dry eye syndrome is one of the most common causes of watery eyes. When the tear glands do not produce enough moisture regularly, the eyes become dry and irritated. The brain then triggers “reflex tearing” to compensate, though these emergency tears often have the wrong chemical composition to stay on the eye surface effectively.
Other triggers for tear overproduction include environmental irritants such as wind, smoke, dust, or bright light. Allergies to pollen, pet dander, or dust mites frequently cause allergic conjunctivitis, leading to excessive tearing alongside itching and redness. Foreign bodies trapped on the eye surface, infections such as blepharitis (inflammation of the eyelid margins), and corneal scratches can all stimulate reflex tearing.
Impaired Tear Drainage (Obstruction)
Under normal circumstances, tears drain through tiny openings called puncta in the inner corner of the eyelids. They flow into the lacrimal sac, then down through the nasolacrimal duct into the nose. If this drainage pathway becomes blocked or narrowed, tears pool on the eye surface and overflow down the cheek.
Common causes of impaired drainage include stenosis (narrowing) of the puncta, blocked tear ducts from inflammation, injury, or age-related changes, and eyelid malposition. Ectropion, where the lower eyelid turns outward, positions the drainage openings away from the tear lake. Entropion, where the eyelid turns inward, causes the lashes to irritate the eye surface, triggering reflex tearing.
Who Is Affected by Epiphora?
Watery eyes can affect anyone, though certain groups are more commonly affected. Understanding the demographics helps explain why the condition develops and what treatment approach may be most appropriate.
Watery Eyes in Infants
Blocked tear ducts affect approximately 5% of newborns, making it a relatively common concern for new parents. The good news is that around 90% of these cases resolve with simple tear duct massage, known as Crigler massage, without requiring surgery. Most cases clear spontaneously by the age of one or two as the tear ducts finish developing. Only infants with symptoms persisting beyond twelve months typically require surgical intervention.
Watery Eyes in Adults Over 60
The condition is most frequently observed in adults over 60. This occurs because the structures supporting the eyelids and tear drainage system naturally weaken or narrow with age. The ligaments and skin surrounding the eyelids lose elasticity, often leading to ectropion, which prevents the tear drainage openings from making proper contact with the eye surface.
Meibomian Gland Dysfunction (MGD) is another significant factor in older adults. Research demonstrates that MGD affects up to 60% of people in this age group. These glands produce the oily layer that prevents tears from evaporating too quickly. When they malfunction, the tear film becomes unstable, triggering the cycle of dryness followed by reflex watery eyes. Notably, prescribed treatments for dry eye cost the NHS in England more than £27 million in 2014 alone, highlighting how widespread this problem has become.
Recognising the Symptoms of Watery Eyes (Epiphora)
While tear overflow is the most obvious symptom, a specialist will look for a range of indicators to determine the underlying cause. The main symptoms of persistent watery eyes include continuous tears running down the cheek even when not crying, redness or irritation of the skin around the eyes due to constant moisture, and temporarily blurred vision from the excess moisture layer.
Additional symptoms may include crusting and discharge around the eyelashes, particularly upon waking, and recurrent eye infections. Blocked tear ducts can create a stagnant pool of fluid that increases infection risk. In some cases, the tear sac becomes swollen and infected, a condition called dacryocystitis, which requires urgent treatment with antibiotics.
How Watery Eyes Are Diagnosed
Accurate diagnosis is essential for effective treatment. At Abbey Wood Hospital, our consultant ophthalmologists conduct thorough examinations to identify the precise cause of your symptoms.
The diagnostic process typically begins with a detailed clinical examination, inspecting the eyelids, tear drainage points, and eye surface for signs of inflammation, infection, or structural abnormalities. A fluorescein dye test may be performed, where special orange dye is applied to the eye. The time it takes for the dye to disappear from the eye surface indicates whether drainage is functioning normally or is slow or blocked.
Syringing and probing is another common diagnostic technique. Saline solution is gently flushed through the tear ducts. If you taste the saline at the back of your throat, the system is at least partially open. If the fluid regurgitates back through the puncta, a blockage is confirmed. In complex cases, specialised imaging and diagnostics may be used to pinpoint the exact location and nature of any obstruction.
Treatment Options for Epiphora
Treatment pathways are highly individualised and depend entirely on the root cause identified during diagnosis. According to Moorfields Eye Hospital guidance, mild cases may not require active treatment, while persistent symptoms benefit from targeted intervention.
Medical Management
When overproduction from irritation, allergies, or dry eye syndrome is the cause, treatment focuses on addressing the underlying trigger. This may involve lubricating eye drops for dry eye-induced tearing, antihistamine drops or tablets for allergic conjunctivitis, or antibiotic drops for infections such as blepharitis or conjunctivitis.
Surgical Options
When drainage problems cause watery eyes (Epiphora), surgical intervention often provides the most effective solution. Punctoplasty is a minor procedure, typically performed under local anaesthetic, to surgically widen narrowed punctal openings and improve drainage.
For blocked tear ducts, Dacryocystorhinostomy (DCR) is the gold standard treatment. This procedure creates a new, direct passage from the lacrimal sac into the nose, bypassing the blockage entirely. DCR can be performed externally or endoscopically through the nose to avoid visible scarring. Success rates are excellent, approximately 90% for external surgery and 85-90% for endoscopic approaches. Remarkably, only 3% of patients notice any surgical scar after three months.
Eyelid surgery may be recommended for ectropion or entropion, repositioning the eyelid to restore proper contact between the puncta and eye surface.
Managing Symptoms at Home
While seeking professional advice is essential for persistent watery eyes, several measures can help manage discomfort in the meantime. Gently wipe away excess tears with a clean tissue, blotting rather than rubbing to prevent skin irritation. Avoid smoky environments, strong winds, and chemical irritants where possible.
Warm compresses can be particularly helpful if watery eyes are linked to blepharitis or Meibomian Gland Dysfunction. Use a microwaveable eye mask or clean flannel dipped in warm water, applied to closed eyelids for five to ten minutes daily. This softens the oils in the glands and helps clear blockages. Wearing sunglasses or wraparound glasses outdoors protects against wind and debris that can trigger reflex tearing.
Frequently Asked Questions
Can watery eyes clear up on their own?
Mild cases often improve without treatment, particularly if caused by temporary irritation or infection. However, structural causes such as blocked tear ducts or eyelid malposition typically require intervention. If symptoms persist beyond a few weeks despite home management, specialist assessment is advisable.
Is DCR surgery painful?
DCR is usually performed under general anaesthetic or local anaesthetic with sedation, so you will not feel pain during the procedure. Post-operative discomfort is typically mild and well controlled with standard painkillers. Most patients return to normal activities within one to two weeks.
Will I have a visible scar after tear duct surgery?
Endoscopic DCR is performed entirely through the nose, leaving no external scar. External DCR does involve a small incision near the inner corner of the eye, but research shows only 3% of patients notice any visible scar after three months. The incision is carefully placed in a natural skin crease to minimise visibility.
Can allergies cause persistent watery eyes (Epiphora)?
Yes, allergies are a common cause of excessive tearing. Seasonal allergies triggered by pollen or perennial allergies to dust mites or pet dander can cause ongoing symptoms. Managing allergies with antihistamines or avoiding triggers usually improves the watering significantly.
When to Seek Specialist Care
You should arrange a consultation with a specialist if watery eyes are persistent and affect daily activities such as driving or reading, if symptoms are accompanied by pain, redness, discharge, or changes in vision, or if the condition does not improve after several weeks of home management.
At Abbey Wood Hospital, you can expect rapid access to consultation, precise diagnosis using advanced techniques, and comprehensive treatment plans delivered in a comfortable, private setting. Our GP services can also provide initial assessment and onward referral if needed.
To arrange a private consultation with one of our specialist ophthalmology consultants in North London, contact the Abbey Wood Hospital appointments team on 020 8358 7100 or book an appointment online.
Please note: This article provides general health information and is not a substitute for professional medical advice. If you experience sudden vision changes, severe eye pain, or signs of infection such as swelling and discharge, seek prompt medical attention.