Watery Eyes: Causes and Treatment

How tears normally drain

Tears are made by the lacrimal gland above the outer corner of each eye. Every blink spreads them over the surface. They then drain through two tiny openings (puncta) at the inner corner of the eyelids, into the tear sac, and down the nasolacrimal duct into the nose. That is why your nose runs when you cry. Watery eyes happen when production outpaces drainage.

Causes of watery eyes

Too many tears (overproduction)

• Dry eye: a poor-quality tear film irritates the surface, which triggers bursts of reflex watery tears. People often have both dryness and watering, worse with screens, reading, wind or air conditioning.
• Allergies: allergic conjunctivitis causes itchy, red, watery eyes, often with sneezing and a runny nose.
• Blepharitis: inflamed eyelid margins with crusting and blocked oil glands destabilize tears.
• Irritants: wind, cold, bright light, smoke, onions, chlorine and makeup.
• Infections: viral conjunctivitis causes watery discharge and grittiness; colds cause watering.
• Foreign body or scratched cornea: sudden watering, pain and grittiness.
• Eyelashes rubbing on the eye: from an inward-turning lid (entropion) or misdirected lashes.
• Facial nerve problems: Bell's palsy prevents full blinking; after recovery, some people get "crocodile tears" while eating.

Poor drainage

• Blocked tear duct (nasolacrimal duct obstruction): watering and sometimes sticky discharge, usually in one eye. In adults it often develops with age, after sinus problems, nasal surgery, facial injury or some medicines. See tear duct stenosis.
• Lower eyelid turning outward (ectropion) or sagging: the drainage opening no longer touches the eye. Common in older adults.
• Narrowed puncta.
• Tear sac infection (dacryocystitis): a painful red swelling at the inner corner with pus.

Watery eyes in babies

About 1 in 10 to 20 newborns has a blocked tear duct because a thin membrane at the end of the duct has not opened. Signs appear in the first weeks: a watery eye, tears spilling onto the cheek and sticky crusting, with a white, comfortable eye. Most resolve by 12 months.

What helps:

• Clean the eyelids with cooled boiled water and a fresh cotton ball for each eye.
• Massage gently: with a clean finger, press firmly downward along the side of the nose from the inner corner of the eye, a few times, 2 to 3 times a day.
• See a doctor if the eye becomes red, the skin is swollen, or watering persists past 12 months. A simple probing procedure opens the duct.

Watering with light sensitivity, a cloudy or enlarged cornea in a baby can be congenital glaucoma, which needs urgent review.

How doctors find the cause

An eye doctor will ask whether one or both eyes are affected, when it happens, and about itching, pain, discharge and allergies. They will:

• examine the eyelids, lashes and tear film with a slit lamp
• check how quickly tears break up (a sign of dry eye)
• check eyelid position and blinking
• flush saline through the drainage system (syringing) to see if it reaches the throat, which tests for blockage
• sometimes order dye tests or imaging of the tear ducts

Treatment

• Dry eye: preservative-free artificial tears 4 or more times daily, screen breaks (the 20-20-20 rule), warm compresses and treatment of blepharitis. Prescription anti-inflammatory drops help moderate dry eye.
• Allergies: antihistamine or mast cell stabilizer eye drops, cold compresses, and avoiding allergens.
• Blepharitis: warm compresses for 5 to 10 minutes and gentle eyelid cleaning daily.
• Infections: most viral conjunctivitis clears in 1 to 2 weeks; antibiotic drops for bacterial infection; oral or IV antibiotics for dacryocystitis.
• Eyelid problems: minor surgery to tighten a sagging lid or correct entropion or ectropion.
• Blocked tear duct in adults: a procedure called dacryocystorhinostomy (DCR) creates a new drainage path from the tear sac into the nose, with high success rates.
• Protection: wraparound glasses in wind and cold.

Avoid "get the red out" decongestant drops for long-term use, as they can cause rebound redness.

Frequently asked questions

Why are my eyes always watering?

Constant watering is most often caused by dry eye, allergies, blepharitis or a blocked tear duct. In older adults, a sagging lower eyelid is common. If it lasts more than a few weeks, an eye doctor can test your tear film and drainage to find the cause.

How can dry eyes cause watery eyes?

When the tear film is poor or evaporates too quickly, the surface of the eye becomes irritated. The eye responds by producing a flood of reflex tears, which are watery and do not lubricate well. Treating the dryness with lubricating drops usually reduces the watering.

Can a blocked tear duct clear on its own?

In babies, yes. Most blocked tear ducts open by 12 months with cleaning and massage. In adults, blockages rarely clear on their own. Persistent watering in adults often needs a procedure such as dacryocystorhinostomy to restore drainage.

When should I see a doctor for watery eyes?

See a doctor if watering lasts more than a few weeks, affects one eye with sticky discharge, or there is pain, redness, light sensitivity, reduced vision, or a painful swelling near the nose. Get emergency care for chemical exposure or sudden severe eye pain with blurred vision.