Excess Tearing: Symptoms, Causes and Treatment

Excess tearing, also known as epiphora, is a condition that affects people of all ages and can significantly impact daily life. Whether it occurs suddenly or develops gradually, excessive tearing often leads to discomfort, blurred vision, and social embarrassment. Understanding the symptoms, underlying causes, and available treatment options is crucial to improving quality of life for those affected. In this comprehensive article, we will explore the key aspects of excess tearing, drawing on up-to-date research to provide you with actionable information for recognizing, diagnosing, and managing this common ocular issue.

Symptoms of Excess Tearing

Excess tearing doesn’t just mean watery eyes—it often comes with a range of other symptoms that can affect comfort, vision, and even emotional well-being. Recognizing these symptoms early can help guide decisions about when to seek medical attention and what questions to ask your healthcare provider.

Recognizing Excess Tearing

Most people notice excess tearing as persistent or frequent watery eyes. This symptom may be mild, only occurring in windy conditions, or it can be severe enough to interfere with vision and daily tasks. In children, parents often notice frequent wiping of the eyes or tears running down the cheeks, sometimes accompanied by discharge that crusts on the eyelids, especially after sleep 2 3 5.

Associated Discomfort and Vision Issues

Excess tearing can cause more than inconvenience. Irritation and a sensation of grittiness are common, resulting from the overflow of tears onto the skin around the eyes, which may become red or sore. In some cases, the continuous presence of tears can blur vision, making reading or driving challenging 1 3.

When to Seek Help

While mild watering may not be concerning, other symptoms—such as persistent discharge, redness, or pain—warrant evaluation by an eye care professional. In infants, excessive tearing can sometimes signal more serious underlying conditions, such as congenital glaucoma, which requires prompt attention 3.

Causes of Excess Tearing

Understanding why excess tearing occurs is essential for effective treatment. The causes can range from simple anatomical blockages to serious eye diseases. Knowing the underlying reason helps to guide appropriate management and prevent complications.

Nasolacrimal Duct Obstruction

The most frequent cause of excess tearing in infants and young children is blockage of the nasolacrimal duct—the channel that drains tears from the eye into the nose 2 3 5. When this duct is blocked, tears cannot drain properly, leading to overflow and sometimes discharge. Congenital nasolacrimal duct obstruction (CNLDO) is common, affecting up to 20% of children in their first year of life 5.

Punctal and Anatomical Abnormalities

The punctum is a tiny opening on the eyelid margin where tears normally enter the drainage system. Abnormalities in the size or structure of the punctum can reduce drainage efficiency, leading to epiphora 1. These changes can be congenital or acquired and are now better understood through advanced imaging techniques such as anterior segment optical coherence tomography (OCT) 1.

Infections and Inflammation

Infections of the eyelids (blepharitis) or the conjunctiva (conjunctivitis) can disrupt tear drainage and increase tear production, both of which contribute to excess tearing 3. Inflammatory conditions may also narrow the drainage passages, compounding the problem.

Foreign Bodies and Other Ocular Conditions

A foreign body in the eye, such as a grain of sand or an eyelash, can cause reflex tearing as the eye tries to flush out the irritant 3. In addition, serious eye diseases like congenital glaucoma can present with excess tearing as an early sign, particularly in infants 3.

Treatment of Excess Tearing

Treatment for excess tearing depends on the underlying cause, severity, and the age of the patient. Options range from conservative approaches to advanced surgical interventions, with the goal of restoring normal tear drainage and alleviating symptoms.

Conservative Management

For many infants with mild nasolacrimal duct obstruction, conservative management is often effective. Gentle massage over the lacrimal sac area can help open the blockage and promote drainage 2 5. Observation is also reasonable, as many cases resolve spontaneously within the first year of life 5.

Probing and Minimally Invasive Procedures

If conservative measures fail, a simple probing procedure can be performed to open the blocked duct. This is usually done in a clinical setting and has a high success rate, especially when performed before one year of age 2 5. For obstructions that persist or recur, repeat probing or more advanced techniques such as silicone tube intubation or balloon catheter dilation may be considered 5.

Surgical Interventions

In rare cases where non-invasive treatments are unsuccessful, especially in older children or adults, surgical intervention such as dacryocystorhinostomy (DCR) may be required. This procedure creates a new pathway for tears to drain into the nasal cavity, bypassing the blocked duct 5.

Managing Other Causes

If excess tearing is due to infection, appropriate antibiotics or anti-inflammatory medications are prescribed 3. In cases of punctal abnormalities, surgical correction may be necessary to restore normal anatomy and function 1. Foreign bodies should be identified and removed promptly to resolve symptoms 3.

Conclusion

Excess tearing can be a frustrating and disruptive condition, but understanding its symptoms, causes, and treatments is the first step toward effective management. Here’s a summary of the main points covered:

• Common symptoms include persistent watering, discharge, blurred vision, and irritation 1 2 3 5.
• Primary causes range from nasolacrimal duct obstruction (especially in infants), anatomical abnormalities, infections, to more rare conditions like congenital glaucoma 1 2 3 5.
• Treatment options vary from conservative measures and minimally invasive procedures to surgical interventions, depending on the cause and severity 2 3 5.
• Prompt evaluation is important, especially in children, to rule out serious underlying conditions and to ensure timely, effective treatment.

If you or your child is experiencing excess tearing, consult an eye care professional for a thorough evaluation and personalized management plan. Early recognition and intervention can greatly improve outcomes and quality of life.