Excess tearing may cause a sensation of watery eyes or result in tears falling down the cheek. Other symptoms, such as eye irritation or pain, may be present depending on the cause.

Most tears are produced in the tear (lacrimal) glands located above the outer part of the upper eyelid. Tears run across the eye and drain through small openings at the inner corners of the eyelids near the nose (the upper and lower puncta) into a short channel (the canaliculus). They then run into the tear sac and through the nasolacrimal duct into the nose. Blockage anywhere along the tear drainage pathway can lead to a watery eye. Blockage also predisposes to infection of the tear sac (dacryocystitis—see Dacryocystitis). Such infection can sometimes spread to tissues around the eye (periorbital cellulitis—see Infections of the Orbit (Preseptal Cellulitis).

Inwardly turned eyelashes that rub against the eyeball (trichiasis—see Trichiasis)

An outwardly turned eyelid (ectropion—see Entropion and Ectropion) that moves the punctum away from its normal position next to the eyeball so that it cannot drain away tears

Age-related narrowing of the tear ducts

Chronic infections in the tear sac

Any disorder that irritates the cornea (the clear layer in front of the iris and pupil) can increase tear production. However, most people with corneal disorders that cause watery eyes (such as a corneal scratch or sore, a foreign object in the eye, or inflammation of the cornea) have significant pain, redness, and/or sensitivity to light, which are the usual reasons they seek medical care.

Evaluation

Not every case of watery eyes requires evaluation by a doctor. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with watery eyes, certain symptoms and characteristics are cause for concern. They include

Repeated, unexplained episodes of red watery eyes

A hard mass in or near the tear duct

When to see a doctor

People with warning signs should see a doctor within a week or so. Other people who are bothered by watery eyes should see a doctor when it is convenient, but typically a delay of several weeks is not harmful.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests the cause of the watery eyes and the tests that may need to be done (see Table: Some Causes and Features of Watery Eyes).

Doctors ask whether the person has

Itching, a runny nose, or sneezing (especially after being exposed to a potential allergen)

Eye irritation, redness, or pain

Pain or discomfort with swelling or redness near the inner corner of the eye

Taken a drug that may cause watery eyes (such as chemotherapy drugs or eye drops containing echothiophate, epinephrine, or pilocarpine)

Doctors then do a physical examination. The physical examination focuses on the face, particularly the eyes and nose. Doctors look for tears running down the cheek. They examine the eyelids, the puncta, and the area at the inner corners of the eyes. They also examine the surface of the eye with a slit lamp to examine the eye under high magnification (see Figure: What Is a Slit Lamp?). The nose is examined for congestion, blockages, pus, discharge, and bleeding.

Some Causes and Features of Watery Eyes

Cause

Common Features*

Disorders that cause excess tear production

Dry eyes

Watering that is worse when eyes are exposed to cold or windy weather, cigarette smoke, or dry heat

A feeling of something in the eye (foreign object [body] sensation) that comes and goes, especially toward the end of the day

Irritation of the eye surface due to

Conjunctivitis (inflammation of the membrane that lines the back of the eyelid and covers the front of the eye) caused by allergies, chemicals, or infection

Blepharitis (inflammation of the edges of the eyelids—see Blepharitis)

An inwardly turned eyelid and eyelashes

Eye redness

In people with allergic conjunctivitis, itching

In people with an inwardly turned eyelid and eyelashes, often a sensation of grittiness or something in the eye

Nasal irritation caused by allergies or an upper respiratory infection

Pain or discomfort near the corner of the eye and along the side of the nose

Often swelling, redness, tenderness, and warmth in the same area

An outwardly turned eyelid

Usually seen during the examination

Tumors

Often in older people

Sometimes a hard lump near the tear sac

Other causes (such as injuries or drugs)

Usually in people who know they have such causes

*Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

Testing

Doctors can usually determine the cause based on the results of the history and physical examination. Testing is often unnecessary. If testing is needed, the person usually is referred to an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders).

Some tests are done in the ophthalmologist's office. Doctors may insert a small probe into the punctum and sometimes the canaliculus to try to detect blockage. They may also gently flush fluid through the canaliculus to see whether the fluid drains into the nose as it should.

Imaging tests and procedures (imaging of the tear ducts, computed tomography [CT], or examination of the inside of the nose with a flexible viewing tube [nasal endoscopy]) are sometimes done.

Treatment

Treatment of other causes

Sometimes artificial tears

Measures to open blocked tear ducts

Underlying disorders are treated. For example, doctors may give a nasal corticosteroid if allergic rhinitis is the cause.

Doctors sometimes recommend the use of artificial tears to decrease watery eyes when dry eyes or eye surface irritation is the cause.

In infants with blocked tear ducts, the blockage often resolves without treatment as the infant grows. Until the infant is about 1 year old, doctors often suggest that parents manually compress the tear sac 4 or 5 times per day to help relieve the obstruction. If the blockage is not relieved by the time the infant is about 1 year old, doctors may do a procedure to open the ducts. The infant is given a general anesthetic, and the doctor inserts a small probe into the tear duct to break through the blockage.

In children with blocked tear ducts, doctors may first try probing the tear duct. If blockage persists, doctors may need to insert a small plastic tube through the tear duct for a few months to keep a drainage pathway open.

In adults with blocked tear ducts, doctors first try different methods to treat the underlying disorder. If these methods do not work, doctors may have to do surgery to make a new drainage pathway for tears.

Essentials For Older People

As people age, the tear ducts often narrow. Such narrowing is a common cause of unexplained watery eyes in older people. However, complete blockage of the tear duct is also possible. Rarely, a tumor of a tear sac is the cause.

Key Points

Common causes of tearing include allergies, dry eyes, inward or outward turning of the eyelids. and infection, narrowing, or blockage of the tear drainage pathway.

Testing, if necessary, can often be done in an ophthalmologist's office.

Other testing, such as dacryoscintigraphy or dacryocystography (imaging tests of the tear ducts) or computed tomography, is necessary when in-office tests do not reveal the cause or doctors suspect a tumor.

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