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Eye Tearing (Epiphora)

What is Eye tearing (epiphora)?

Epiphora, commonly called excessive eye tearing, is the production of **more tears than the eye can handle**. Normally, tears lubricate the surface of the eye, keep it clear of debris, and flow through tiny drainage canals (the puncta, canaliculi, and nasolacrimal duct) into the nose. When production outpaces drainage, tears spill over the eyelid margin and onto the cheek.

While occasional tearing is normal—especially after laughing, cutting onions, or during windy weather—persistent or profuse tearing should be evaluated because it often signals an underlying ocular or systemic problem.

Common Causes

Below are the most frequent reasons people develop epiphora. Some are benign, while others require prompt medical attention.

• Dry‑eye syndrome – Paradoxically, insufficient lubrication can stimulate reflex tearing.
• Blocked nasolacrimal drainage system – Common in children (congenital dacryostenosis) and adults (nasolacrimal duct obstruction).
• Eyelid malposition – Drooping (ptosis) or outward turning (ectropion) prevents tears from spreading evenly.
• Allergic conjunctivitis – Histamine release causes itching, redness, and watery discharge.
• Infections – Bacterial or viral conjunctivitis, blepharitis, or a stye (hordeolum).
• Inflammatory eye diseases – Conditions such as uveitis or scleritis increase tear production.
• Foreign body or corneal abrasion – Mechanical irritation triggers reflex tearing.
• Blepharitis & meibomian gland dysfunction – Alters tear film stability leading to overflow.
• Environmental irritants – Smoke, wind, chlorine, or strong perfume.
• Systemic disorders – Autoimmune diseases (e.g., Sjögren’s), thyroid eye disease, or neurologic conditions affecting facial nerves.

Associated Symptoms

Eye tearing rarely occurs in isolation. Patients often notice one or more of the following:

• Redness of the conjunctiva (pink eye)
• Itching, burning, or gritty sensation
• Blurred vision that improves after blinking
• Crusty or sticky discharge, especially upon waking
• Sensitivity to light (photophobia)
• Swelling of the eyelids or surrounding skin
• Feeling of a foreign body under the eyelid
• Recurrent eye infections
• Facial pain or headache (particularly with sinus involvement)

When to See a Doctor

Most cases of epiphora are not emergencies, but you should schedule an eye‑care appointment if you notice any of the following:

• Persistent tearing for more than **two weeks** without an obvious trigger.
• Accompanying pain, redness, or swelling that does not improve with over‑the‑counter lubricants.
• Discharge that is thick, yellow/green, or foul‑smelling – signs of infection.
• Vision changes (double vision, sudden blurriness, or loss of visual field).
• History of eye injury, recent surgery, or a known blockage of the nasolacrimal duct.
• Children under 1 year who have constant tearing or a yellow crust around the eye.

Diagnosis

Eye specialists (ophthalmologists or optometrists) use a systematic approach to determine the cause of epiphora.

History & Physical Examination

• Detailed symptom timeline, exposure to allergens or irritants, and past ocular history.
• Inspection of eyelid position, lid margin, and tear film quality.
• Assessment of the nasal passage for blockage.

Special Tests

• Fluorescein dye test – Highlights corneal abrasions or ulcerations.
• Schirmer test – Measures baseline tear production to rule out dry eye.
• Nasolacrimal duct patency tests – The Jones test (fluorescein dye injected into the canaliculi) and dacryocystography (contrast X‑ray) evaluate drainage.
• Eyelid eversion – Checks for entropion (inward turning lid) or trichiasis (misdirected lashes).
• Allergy testing – Skin prick or serum specific IgE if allergic conjunctivitis is suspected.

Treatment Options

Treatment is guided by the underlying cause and severity of tearing.

Medical (Pharmacologic) Management

• Artificial tears – Preserved‑free lubricating drops relieve reflex tearing from dry‑eye syndrome.
• Antihistamine or mast‑mast cell stabilizer drops – For allergic conjunctivitis (e.g., olopatadine, ketotifen).
• Topical antibiotics – Used for bacterial conjunctivitis or blepharitis.
• Corticosteroid eye drops – Short‑term use for inflammatory conditions such as uveitis; must be prescribed.
• Systemic medications – Oral antihistamines for severe allergy, or doxycycline for meibomian gland dysfunction.

Procedural & Surgical Options

• Punctal dilation or silicone plugs – Temporarily block tear drainage in cases of dry eye‑related reflex tearing.
• Lacrimal probing and intubation – First‑line for nasolacrimal duct obstruction, especially in children.
• Dacryocystorhinostomy (DCR) – Surgical creation of a new drainage pathway for chronic adult obstruction.
• Eyelid surgery – Corrects ectropion, entropion, or ptosis that interfere with proper tear spread.
• Meibomian gland expression or thermal pulsation – Improves lipid layer quality in meibomian gland dysfunction.

Home & Lifestyle Measures

• Apply a warm compress (5–10 minutes, 2–3 times daily) to improve meibomian gland flow.
• Maintain eyelid hygiene: gentle cleansing with diluted baby shampoo or commercially available lid wipes.
• Avoid known irritants—smoke, strong fragrances, and windy environments.
• Use a humidifier in dry indoor settings.
• Wear protective goggles during activities that generate dust or chemicals.

Prevention Tips

While not all causes are preventable, many strategies can reduce the risk of developing epiphora.

• Manage dry‑eye risk factors: limit contact‑lens wear time, take regular screen breaks, and stay hydrated.
• Control allergies with daily antihistamine eye drops or oral medications during high‑pollen seasons.
• Practice good eyelid hygiene to prevent blepharitis and stye formation.
• Promptly treat sinus infections or nasal allergies, as congestion can impair tear drainage.
• Protect eyes from trauma; wear safety glasses when working with tools or chemicals.
• Schedule routine eye examinations (at least every 1–2 years) to catch early lid or drainage abnormalities.

Emergency Warning Signs

Key Takeaways

Epiphora is a common symptom with a broad differential diagnosis ranging from simple allergies to serious orbital infections. Understanding when tearing is merely a nuisance versus a signal of disease empowers patients to seek timely care. If tearing is persistent, painful, or linked with vision changes, schedule an eye‑care visit promptly. Early diagnosis and targeted treatment—whether medical therapy, simple lid hygiene, or surgical correction—can restore comfort and protect eye health.

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References:

1. Mayo Clinic. “Epiphora (excessive tearing).” mayoclinic.org. Accessed March 2024.
2. American Academy of Ophthalmology. “Dry Eye.” aao.org. 2023.
3. Centers for Disease Control and Prevention. “Allergic Conjunctivitis.” cdc.gov. 2022.
4. National Eye Institute. “Nasolacrimal Duct Obstruction.” nei.nih.gov. Updated 2024.
5. Cleveland Clinic. “Blepharitis.” my.clevelandclinic.org. 2023.
6. World Health Organization. “Guidelines on the Management of Eye Infections.” WHO, 2021.

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