Chronic Tearing: Causes and Treatment Guide

An eye that constantly waters does not always produce too many tears. In many cases, the problem is related to ocular surface irritation, abnormal eyelid position, or a tear drainage system that is not working properly.

This guide to treating chronic tearing explains the most common causes, how the problem is evaluated, and which treatments may be appropriate depending on the underlying condition.

Persistent tearing can cause intermittent blurred vision, skin irritation, difficulty reading or driving, and the constant need to wipe the eyes. Identifying the cause is important because not every patient requires the same treatment.

What is considered chronic tearing?

Chronic tearing refers to persistent excessive tearing from one or both eyes over several weeks or longer.

Tears normally lubricate and protect the ocular surface. They then drain through small openings in the eyelids, called puncta, and travel through the tear drainage system into the nose.

Excessive tearing usually occurs for one of two main reasons:

• The eye produces too many tears because of irritation

• Tears are produced normally but cannot drain properly

Distinguishing between these two mechanisms is the first step in choosing the appropriate treatment.

What are the most common causes of chronic tearing?

One of the most common causes is dry eye. Although it may seem contradictory, a dry or irritated ocular surface can trigger excessive reflex tearing. These tears are often more watery and do not necessarily lubricate the eye effectively.

Other causes of tearing include:

• Allergies

• Blepharitis

• Conjunctivitis

• Eyelashes rubbing against the eye

• Irritation from smoke, dust, or cosmetics

• Abnormal eyelid position

• Tear duct obstruction

For this reason, using eye drops without identifying the cause may provide temporary relief without correcting the underlying problem.

How does a blocked tear duct cause tearing?

When tears cannot drain normally into the nose, they accumulate on the surface of the eye and eventually spill onto the cheek.

The obstruction may be located at the puncta, canaliculi, or nasolacrimal duct.

Some patients may also experience:

• Discharge or crusting

• Recurrent infections

• Debris along the eyelashes

• Swelling near the inner corner of the eye

• Pain near the side of the nose

When a true obstruction is present, eye drops generally cannot correct it, and a procedure may be necessary to restore normal drainage.

How can eyelid position cause watery eyes?

The eyelids help distribute tears across the eye and direct them toward the tear drainage openings.

When the eyelid is loose or positioned abnormally, tears may not enter the drainage system properly.

Ectropion, for example, occurs when the eyelid turns outward. In addition to tearing, it may cause irritation, redness, and exposure of the ocular surface.

In these cases, treating the tear drainage system alone would not solve the problem. Treatment must also address eyelid position and function.

How is chronic tearing evaluated?

The evaluation begins by determining how long the problem has been present, whether it affects one or both eyes, and whether there is associated discharge, pain, irritation, or recurrent infection.

The examination may include:

• The cornea and ocular surface

• Tear film quality

• Eyelid position

• Tear drainage openings

• Eyelid closure

• Presence of inflammation or discharge

In some patients, tear drainage testing or irrigation of the tear drainage system with sterile solution may be performed to determine whether an obstruction is present and where it is located.

More than one condition can also contribute to tearing. For example, a patient may have both dry eye and eyelid laxity. This is why all of the structures involved should be evaluated together.

How is chronic tearing treated?

Treatment depends directly on the cause.

When dry eye or ocular surface inflammation is present, treatment may include appropriate lubricating drops, eyelid hygiene, and therapies designed to improve the tear film.

If allergies, blepharitis, or another source of irritation is responsible, treatment should focus on controlling that condition.

When the tear drainage openings are narrowed, a procedure may be performed to improve their opening.

If the obstruction is located deeper within the tear drainage system, treatment may include probing, silicone tube placement, or a procedure such as dacryocystorhinostomy (DCR), which creates a new drainage pathway between the lacrimal sac and the nose.

When tearing is caused by abnormal eyelid position or laxity, oculoplastic surgery may help restore both normal tear drainage and protection of the ocular surface.

When should chronic tearing be evaluated?

An evaluation is recommended when tearing:

• Persists for several weeks

• Mainly affects one eye

• Requires constant wiping

• Frequently causes blurred vision

• Is associated with discharge

• Has caused recurrent infections

• Continuously irritates the skin around the eye

More urgent evaluation is recommended if there is severe pain, decreased vision, swelling near the side of the nose, significant discharge, eye trauma, or difficulty closing the eye.

Frequently asked questions about chronic tearing

Can chronic tearing go away on its own?

It depends on the cause. Temporary irritation may improve when the trigger disappears, but a tear duct obstruction or persistent eyelid abnormality usually requires treatment.

Can artificial tears help?

Yes, when tearing is caused by dry eye or ocular surface irritation. However, artificial tears cannot correct a blocked tear duct or an anatomical eyelid problem.

Does chronic tearing always require surgery?

No. Many cases can be treated medically. Surgery is considered when there is an anatomical abnormality, significant tear duct obstruction, or an eyelid problem that cannot be corrected with medication alone.

Does tear duct surgery leave a visible scar?

It depends on the procedure. Both external and endoscopic approaches are available. The choice should be based primarily on the location of the obstruction, the patient's anatomy, and the likelihood of restoring effective tear drainage.

Persistent watery eyes should not simply be accepted as part of everyday life. A complete evaluation can determine whether the problem originates from the ocular surface, the eyelids, or the tear drainage system and identify the most appropriate treatment.

In Dr. Andrés Lozano’s practice, the evaluation combines ophthalmology and oculoplastic surgery to assess the ocular surface, eyelids, and tear drainage system together.