What is epiphora?
Epiphora is the medical term for excessive tearing or watery eyes, a condition in which tears overflow onto the face rather than draining normally through the tear drainage system. While tearing in response to emotion, irritation, or cold wind is a normal reflex, epiphora refers to persistent, uncontrolled overflow of tears that occurs during routine daily activities and is not triggered by an obvious external cause.
Tears are produced continuously by the lacrimal gland and play an essential role in keeping the surface of the eye moist, clear, and protected. Under normal circumstances, tears drain through small openings at the inner corner of the eyelids, travel through a series of channels, and empty into the nasal cavity. When this balance is disrupted, either because the eye is producing too many tears or because the drainage system cannot keep up with normal tear production, tears spill onto the face.
Types of epiphora
Epiphora is broadly classified by its underlying mechanism:
- Hypersecretory epiphora is caused by overproduction of tears. The drainage system is functioning normally but cannot keep pace with the excess volume of tears being produced. This type is typically triggered by irritation of the eye's surface, allergies, or reflex tearing in response to dry eye.
- Obstructive epiphora is caused by a partial or complete blockage somewhere in the tear drainage pathway that prevents tears from draining at a normal rate. This is the most common type in adults and is often related to age-related narrowing of the drainage channels.
- Mixed epiphora is a combination of both overproduction and drainage insufficiency contributing to overflow tearing simultaneously.
What are the symptoms of epiphora?
The primary symptom of epiphora is tears that overflow onto the face during normal daily activity. Depending on the underlying cause, additional symptoms may include:
- Tears spilling down the cheeks without an obvious emotional or environmental trigger
- Blurred or fluctuating vision caused by excess moisture on the surface of the eye
- Redness or irritation at the inner corner of the eye or on the skin of the cheeks from chronic wetness
- Crusting or discharge along the eyelid margin or at the inner corner of the eye
- A feeling that something is in the eye, triggering reflex tearing
- Swelling or tenderness near the inner corner of the eye if a tear drainage infection is present
- Skin breakdown or redness on the cheeks from constant dabbing or wiping
Epiphora can affect one or both eyes and may be constant or intermittent depending on the cause. In some patients, symptoms are worse in cold or windy conditions, during activities that require sustained visual attention, or when looking downward.
What causes epiphora?
Epiphora develops when the volume of tears on the eye's surface exceeds the capacity of the drainage system to remove them. This can result from increased tear production, reduced drainage capacity, or both. Common causes include:
- Narrowing or blockage anywhere along the tear drainage pathway that reduces the rate at which tears can drain and leads to overflow
- Entropion, a condition in which the lower eyelid turns outward and causes eyelid malposition
- Dry eye disease
- Eye surface irritation, such as allergies, ingrown eyelashes, or foreign bodies
- Punctal stenosis, the narrowing of the small drainage openings at the inner corner of the eyelids
- Weakness of the muscles around the eye
How is epiphora diagnosed?
Diagnosing epiphora requires identifying not just that excessive tearing is present but why it is occurring. A provider will take a thorough history of the symptoms and perform a clinical examination that includes:
Evaluation of the eyelid position and the drainage openings at the inner corner of the eyelids
Assessment of the eye's surface for signs of dryness, irritation, or inflammation
A dye disappearance test in which a fluorescent dye is placed on the eye's surface and observed to see how quickly it clears through the drainage system
Probing and irrigation of the tear drainage system to assess patency and identify the location of any obstruction
Nasal endoscopy when a problem at the nasal end of the drainage system is suspected
Imaging studies such as dacryocystography, an imaging technique that visualizes the tear drainage pathway, may be used to map the location and extent of a blockage when surgical treatment is being planned.
How is epiphora treated?
Treatment is directed at the underlying cause of the excessive tearing. When epiphora is driven by reflex tearing in response to dry eye, allergies, or surface irritation, treating the underlying condition is the first step. This may include lubricating eye drops, allergy medications, lid hygiene, or other targeted treatments depending on the diagnosis.
When the lower eyelid is turned outward or the drainage openings are not positioned correctly against the eye's surface, surgical correction of the eyelid position restores normal tear entry into the drainage system. Ectropion repair or punctal procedures may be recommended depending on the specific finding.
When narrowing of the drainage openings is contributing to epiphora, a minor in-office procedure to dilate or surgically widen the openings can improve tear drainage. In some cases a punctal plug that has been placed for dry eye management may need to be removed if it is contributing to overflow tearing.
When epiphora is caused by a complete or significant obstruction that does not respond to simpler measures, dacryocystorhinostomy (DCR) is the most effective long-term solution. DCR creates a new drainage pathway between the tear sac and the nasal cavity, bypassing the obstructed segment entirely. The procedure can be performed through an external incision alongside the nose or entirely through the nasal cavity using an endoscopic approach with no visible external scar.
Recovery following DCR is generally well tolerated, with most patients experiencing lasting resolution of their excessive tearing once the new drainage pathway has fully healed.
Persistent watery eyes affect far more than comfort. They can blur your vision, irritate your skin, and make everyday tasks genuinely frustrating. The good news is that once the underlying cause is identified, epiphora is very treatable. The oculofacial plastic surgeons at The Iowa Clinic will evaluate your tear drainage system and determine the most effective path forward. Call 515.875.9480 to schedule an appointment.