Epiphora: Symptoms, Causes and Treatment

Epiphora, commonly known as excessive tearing, is a frequent complaint that can significantly impact daily life. While tears are essential for eye health, their overproduction or improper drainage leads to constant watering of the eyes, which can be both uncomfortable and socially distressing. Understanding the symptoms, underlying causes, and available treatments for epiphora is crucial for patients and healthcare providers alike. In this article, we will explore the core aspects of epiphora based on current research and clinical experience.

Symptoms of Epiphora

Experiencing epiphora goes beyond simple watery eyes. The condition can affect how you interact with your environment, your comfort, and even your self-confidence. Recognizing the characteristic symptoms is the first step toward effective management.

Symptom	Description	Impact on Patients	Source(s)
Excess tearing	Persistent overflow of tears onto the face	Discomfort, embarrassment	3 4 5
Blurred vision	Tears disrupt clarity of sight	Difficulty with daily activities	3 4
Ocular irritation	Sensation of grittiness or foreign body	Discomfort, worsens in dry climates	3
Activity limitation	Difficulty reading, watching TV, outdoors	Reduced quality of life	3

Table 1: Key Symptoms

Understanding the Symptoms

Epiphora presents in a variety of ways, but all share one common thread: an abnormal flow of tears.

Excess Tearing

The hallmark symptom is constant or intermittent overflow of tears from the eyes. This may be present in one or both eyes and can vary in severity. Some people may notice tears only in windy or cold conditions, while others experience it persistently, regardless of the environment 3 4 5.

Blurred Vision and Visual Disturbance

Excessive tearing can create a persistent film over the eye surface, leading to blurred vision. For some, this makes activities such as reading, driving, or watching television challenging 3 4.

Ocular Irritation

Many patients with epiphora also report a gritty, burning, or foreign body sensation in the eyes. These sensations can be aggravated in hot, dry climates or when exposed to environmental irritants 3.

Impact on Daily Activities

Epiphora can significantly disrupt daily life. Commonly affected activities include:

• Reading or using digital devices
• Watching television
• Being outdoors in windy or cold weather

Women and older adults may be more affected during certain tasks, and the condition can negatively impact self-esteem and general happiness 3.

Emotional and Social Effects

While not always discussed, the embarrassment of uncontrolled tearing can affect self-confidence and interpersonal relationships. Some patients report avoiding social situations or feeling self-conscious about their appearance 3.

Causes of Epiphora

Epiphora is a symptom with many possible underlying causes. Correctly identifying the root cause is essential for effective treatment. Some causes are anatomical, while others are related to tear production or systemic conditions.

Cause	Mechanism	Prevalence/Notes	Source(s)
Lacrimal obstruction	Blockage in drainage passages	Most common in adults	5 6 8 7 9
Reflex tearing	Overproduction due to eye irritation/dryness	Most common in some populations	8
Eyelid malposition	Ectropion, entropion affect tear flow	More common in elderly	5 8
Functional	Drainage delay without anatomical blockage	Under-recognized, common	6 8
Medications	Chemotherapy (e.g., docetaxel) causing narrowing	Adverse effect in cancer patients	2
Infections/inflammation	Sinusitis or conjunctivitis blocking ducts	Associated with rhinosinusitis	1 4
Tumors/masses	Rare, physical blockage of duct	Unusual causes	7 9
Congenital	Incomplete duct development in children	Common in pediatric cases	13

Table 2: Major Causes of Epiphora

Anatomical Obstruction

Most adult cases of epiphora are caused by a blockage somewhere in the lacrimal drainage system—either at the puncta (opening in the eyelid), canaliculi, lacrimal sac, or nasolacrimal duct. These blockages can result from:

• Scarring due to infection or trauma
• Age-related narrowing
• Tumors or rare cysts
• Granulomas or other abnormal tissue growths that physically block the tear outflow 5 6 7 9

Reflex Tearing

Ironically, dry eye syndrome is a leading cause of excessive tearing. When the ocular surface becomes too dry or irritated, the eye responds by producing more tears, overwhelming the normal drainage capacity. This “reflex” tearing is especially common in certain populations, such as older adults and some ethnic groups 8.

Eyelid Malposition

Conditions like ectropion (outward turning of the eyelid) or entropion (inward turning) can disrupt normal tear flow, leading to pooling and overflow. These structural changes are more prevalent with advancing age 5 8.

Functional Epiphora

Functional epiphora refers to delayed drainage of tears despite no detectable anatomical blockage. Diagnostic imaging may show a normal-appearing drainage system but delayed passage of dye or tears. This under-recognized cause can be as common as anatomical blockages, especially when advanced imaging is used 6.

Medication-Induced Epiphora

Some systemic medications, such as the chemotherapy drug docetaxel, can cause narrowing or blockage of the tear ducts as a side effect. This form of epiphora is particularly important to recognize in patients being treated for cancer, as it can significantly affect quality of life 2.

Infections and Inflammation

Chronic rhinosinusitis (inflammation of the nasal and sinus passages) has been linked to acquired epiphora. Inflammation and mucosal swelling at the nasal end of the nasolacrimal duct can impede tear drainage. Treating the underlying sinus condition may resolve the tearing in some cases 1. Acute or chronic conjunctivitis and other ocular surface diseases can also lead to excessive tearing 4.

Rare and Unusual Causes

Tumors, cysts (such as nasolacrimal duct orifice cysts), and even granulomas can cause epiphora by physically blocking tear outflow. While rare, these causes should be considered, especially in cases that do not respond to standard treatments 7 9.

Congenital Causes

In children, the most frequent cause is incomplete development of the nasolacrimal duct, resulting in congenital obstruction. Most cases resolve spontaneously, but persistent cases may require intervention 13.

Treatment of Epiphora

Managing epiphora involves addressing its underlying cause. Treatments range from simple lifestyle modifications to advanced surgical interventions. An individualized approach is key for optimal results.

Treatment Option	Indication	Outcome/Effectiveness	Source(s)
Artificial tears/lubrication	Reflex tearing from dry eye	Symptom improvement common	8
Eyelid surgery	Eyelid malposition	High success rates	5
Balloon dacryocystoplasty	Partial duct obstruction	Minimally invasive, good outcomes	10 12
Dacryocystorhinostomy (DCR)	Complete nasolacrimal duct obstruction	Gold standard, high success	11 13 14
Medication adjustment	Drug-induced epiphora (e.g., docetaxel)	May resolve with dose modification	2
Treat underlying infection/inflammation	Rhinosinusitis, conjunctivitis	May obviate need for surgery	1 4
Observation	Mild or self-limited cases	Often resolves in children	13

Table 3: Overview of Treatment Options

Non-Surgical Treatments

For many patients, especially those with reflex tearing or mild symptoms:

• Artificial tears and lubricating drops can help stabilize the tear film and reduce irritation, thereby decreasing reflex tearing 8.
• Treating underlying eye surface diseases or environmental contributors—such as allergies or exposure to wind/dust—can also be beneficial.
• In cases of drug-induced epiphora, adjusting or discontinuing the causative medication (after consulting with the prescribing physician) may alleviate symptoms 2.

Eyelid Surgery

For patients whose epiphora is due to eyelid malposition, surgical correction of ectropion or entropion is often curative. This is particularly important in older adults, where age-related eyelid laxity is a common culprit 5.

Minimally Invasive Procedures

Balloon Dacryocystoplasty is an emerging technique for treating partial nasolacrimal duct obstructions. A small balloon catheter is used to dilate the narrowed segment, restoring tear flow. This procedure is less invasive than traditional surgery and has shown promising results in select patients 10 12.

Surgical Treatments

The most definitive treatment for anatomical blockages of the lacrimal system is Dacryocystorhinostomy (DCR), which creates a new drainage pathway between the lacrimal sac and nasal cavity. DCR can be performed externally or endoscopically and boasts high success rates, even in cases resistant to other treatments 11 13 14. Newer laser-assisted approaches provide less invasive options with similar long-term outcomes 14.

Pediatric Management

In children with congenital nasolacrimal duct obstruction, conservative management (such as massage and observation) is often sufficient, as many cases resolve spontaneously. For persistent cases, probing or surgical intervention may be necessary, and a multidisciplinary approach has shown high success rates 13.

Treating Underlying Infections and Inflammation

For cases caused by sinusitis or conjunctivitis, addressing the root infection or inflammation may resolve the epiphora without the need for surgical intervention. This highlights the importance of thorough evaluation and collaboration between specialties 1 4.

Multifactorial and Functional Cases

When multiple contributing factors exist, treatment must be individualized. In cases of functional epiphora (where no anatomical cause is found but tear drainage is delayed), advanced imaging and expert evaluation are needed to guide management. Sometimes, observation or minimally invasive interventions are considered 6 8.

Conclusion

Epiphora is a multifaceted condition with a wide range of causes and treatments. Its impact on daily life—physically, emotionally, and socially—can be significant, but with proper understanding and management, most patients can achieve relief.

Key Takeaways:

• Symptoms include excess tearing, blurred vision, ocular irritation, and activity limitation, all of which can impact quality of life 3 4 5.
• Causes range from anatomical obstruction and eyelid malposition to reflex tearing, medication side effects, infection, inflammation, and rare tumors or congenital defects. Multifactorial and functional cases are common and require expert evaluation 1 2 5 6 7 8 9 13.
• Treatment depends on the underlying cause and may include conservative measures, lubrication, medication adjustment, minimally invasive procedures, or surgery. Dacryocystorhinostomy remains the gold standard for anatomical blockages, while balloon dacryocystoplasty and new laser techniques offer promising alternatives 8 10 11 12 13 14.
• Interdisciplinary care and a personalized approach are crucial for optimal outcomes, especially in complex or pediatric cases 1 13.

If you experience persistent watery eyes, consult an eye care professional for a thorough evaluation and tailored treatment plan.