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Tearing and Drainage Problems: Causes, Diagnosis, and Treatment
Common Causes of Watery Eyes
Several different conditions can lead to tearing, and more than one can be present at the same time. Understanding the most common causes helps you recognize what may be happening with your own eyes.
Dry eye is the most frequent cause of watery eyes in adults. When the surface of the eye dries out, the brain responds by triggering a flood of reflex tears. The result is an eye that alternates between feeling dry and gritty and then suddenly overflowing. Treating the dryness itself, rather than the tearing, is the key to breaking this cycle.
Your lower eyelid acts like a small gutter, guiding tears toward the drainage opening at the inner corner of the eye. When the lid sags outward (a condition called ectropion) or turns inward (entropion), tears cannot reach that opening and spill over the edge instead. Weakness from facial nerve problems or age-related muscle changes can have a similar effect. These conditions are typically corrected with a short outpatient procedure to restore proper lid position.
The punctum is the tiny opening on the inner edge of each eyelid where tears first enter the drainage system. This opening can narrow from chronic inflammation, long-term use of certain eye drops, prior radiation, or autoimmune conditions. A narrow punctum is often correctable in the office with a simple widening procedure or a small silicone stent to keep it open while it heals.
The nasolacrimal duct is the channel that carries tears from the tear sac down into the nose. Age-related narrowing is common in adults, and it occurs more often in women. Facial trauma, chronic sinus disease, and small calcium deposits called tear duct stones can also cause a blockage. A blocked duct often causes tearing on one side only and can lead to repeated infections at the inner corner of the eye.
Pollen, dust, smoke, cold air, and wind can all stimulate excess tear production. Prolonged screen use reduces your blink rate significantly, which disrupts the tear film and can trigger reflex tearing as well. These triggers do not usually damage the drainage system, but they can push a system that is already borderline into overflow.
Symptoms and Warning Signs
The pattern of your tearing offers important clues about the underlying cause. Paying attention to when it happens, which eye is affected, and any other symptoms that accompany it will help your care team reach a diagnosis more quickly.
If tears run down your cheek rather than simply welling up on the lid, if one eye is noticeably worse than the other, or if you notice a small bump or pus at the inner corner of the eye, the drainage system is likely involved. Tenderness or swelling at the inner corner can signal an infected tear sac, which needs prompt attention.
Tearing that comes and goes throughout the day, worsens with reading or screen time, affects both eyes similarly, and improves temporarily with artificial tears usually points to dry eye as the root cause. Burning, grittiness, and vision that blurs and then clears with a blink are other common signs of dry eye driving the overflow.
Some symptoms alongside tearing require same-day evaluation. Seek care right away if you have sudden tearing with eye pain, significant vision loss, a red or very swollen eye, discharge that looks like pus, a chemical splash, or tearing that starts after an injury to the face or eye. A painful lump at the inner corner of the eye that is growing also warrants urgent attention.
How We Find the Cause
A thorough evaluation of watery eyes goes beyond a standard eye exam. Our team examines your eyelids, tear film, drainage openings, and the drainage channel itself to identify where the breakdown is occurring.
We begin by looking at your eyelid position, how fully you blink, the quality of your tear film, and the health of the eye surface using a slit lamp, which is a microscope designed for examining the eye up close. We also check the size and shape of the drainage openings and look for any tenderness or swelling at the inner corner.
A small drop of orange dye is placed in each eye. After five minutes, we check how much remains on the surface. Dye that lingers on one side indicates poor drainage on that side rather than overproduction of tears. This simple test is often the first step in separating a drainage problem from a surface problem.
After numbing the area with drops, we gently flush the tear duct with a small amount of sterile saline. If you taste the fluid in the back of your throat, the duct is open. If the fluid backs up out of the eye, a blockage is confirmed. This test is quick and usually well tolerated.
For complex cases, a CT scan or a specialized tear duct imaging study called a dacryocystogram can map exactly where a blockage sits and how extensive it is. Imaging is most useful when surgery is being planned or when we need to rule out a growth or mass in the drainage pathway.
Treatment Options
Treatment depends entirely on the cause. Many patients benefit from straightforward in-office care, while others require a surgical procedure to restore normal drainage. Our Oculoplastic Surgeon is fellowship-trained through the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) and performs all surgical eyelid and tear duct procedures at The Eye Center.
When reflex tearing is driving the problem, restoring tear quality is the goal. Preservative-free artificial tears used throughout the day, warm compresses to improve gland function along the eyelid margin, and prescription anti-inflammatory drops can settle the surface and reduce overflow tearing. Treating dryness first is often enough to resolve the watering without any procedure.
A brief outpatient procedure can correct a lid that sags outward or turns inward. The surgery is performed under local anesthesia, typically takes less than an hour, and restores the lid to a position where tears can flow naturally toward the drainage opening. Recovery involves cold compresses for a few days and modest activity restrictions for about a week.
A punctum that has narrowed can be gently enlarged in the office using a small instrument. In some cases, a tiny silicone tube called an intubation stent is placed to hold the opening open while tissue heals around it. These are minor procedures performed with numbing drops and do not require a trip to a surgical center.
For infants with persistent tearing from a closed membrane at the bottom of the tear duct, a simple probing procedure uses a fine instrument to open the blockage. The procedure is performed under a brief general anesthetic for the child's comfort and carries a high success rate, particularly when done during the first year or two of life.
Dacryocystorhinostomy, known as DCR, creates a new passage from the tear sac directly into the nose, bypassing the blocked duct entirely. The procedure can be performed through a small skin incision or entirely through the nostril with an endoscope. Most patients go home the same day and return to normal activities within one to two weeks. Success rates are consistently high in published surgical series.
When the drainage channels within the eyelid itself are extensively scarred, a small glass tube called a Lester Jones tube may be placed to create a new route for tears from the inner corner of the eye into the nose. This is the established surgical approach for cases where the standard drainage channels cannot be repaired. The tube requires periodic maintenance checks to ensure it remains in place and functioning.
Tearing in Specific Situations
Certain circumstances create their own tearing patterns. Knowing what to expect in these situations can help you make sense of what you are experiencing and when to seek care.
Approximately six out of one hundred newborns have a small membrane at the bottom of the nasolacrimal duct that did not fully open before birth. The majority open on their own during the first year of life. Gentle massage over the tear sac several times a day with clean hands can encourage the membrane to open. If tearing continues past the first birthday or the child has repeated eye infections, a probing procedure is the next step.
Eyelid surgery, including cosmetic blepharoplasty and ptosis repair, can temporarily shift lid position or alter how tears reach the drainage opening. Mild tearing in the first few weeks is common and usually resolves on its own. Tearing that persists beyond six weeks after surgery should be evaluated, since small corrections can restore normal drainage without a full repeat procedure.
The tear duct empties into the nasal cavity very close to structures that are commonly affected by chronic sinus disease and nasal polyps. Inflammation or swelling in this area can compress or block the duct from the outside. Treating the sinus condition often improves tearing, and when DCR surgery is needed, coordinating it with sinus treatment can improve overall results.
Some chemotherapy medications and long-term use of certain eye drops can cause the drainage channels to narrow or scar over time. Let us know about every medication and eye drop you use regularly. While stopping the medication is not always possible, early placement of a stent or other preventive measures can reduce the risk of permanent scarring.
Day-to-Day Care While You Wait for Treatment
There are practical steps you can take between appointments to reduce tearing and protect the skin around your eye. These habits do not replace treatment, but they can make a real difference in comfort.
Small adjustments to your daily routine can reduce how much your eyes water and how much discomfort you feel while you wait for your appointment or during recovery.
- Wear wrap-around sunglasses outdoors to block wind and cold air
- Use preservative-free artificial tears several times a day
- Apply a warm compress to closed eyelids for ten minutes each morning
- Run a humidifier at your desk or bedside if the air in your home is dry
- Take a short break from screens every twenty minutes to encourage blinking
These measures are especially helpful when reflex tearing from dry eye is part of the picture.
Constant wiping breaks down the delicate skin below the eye, leading to redness and cracking. Blot rather than rub when you need to clear your eye. A thin layer of plain petrolatum ointment on irritated skin can serve as a gentle barrier. Avoid perfumed creams and harsh cleansers near the eye, as these can aggravate the surface further.
Reach out to your care team sooner than your scheduled appointment if tearing does not improve with artificial tears after two weeks, if you develop a painful or growing lump at the inner corner of the eye, if one eye begins tearing significantly more than the other, or if your vision starts to blur and does not clear after blinking.
Frequently Asked Questions
Below are answers to questions we hear often from patients dealing with tearing and drainage problems. These answers focus on practical decision guidance that goes beyond what is covered in the sections above.
Yes, lacrimal sac massage is a recommended first step for infants with a blocked tear duct. Using a clean fingertip, apply firm but gentle pressure just below the inner corner of the eye and stroke downward toward the nose. This creates pressure that can help push the blocking membrane open. Doing this three to five times per session, several times a day, works best. If you are unsure of the technique, ask us to demonstrate it at your visit so you can practice with confidence.
Punctal plugs are designed to reduce drainage when dry eye is the primary issue, so they are not appropriate for patients whose tearing is caused by a blocked duct or poor lid position. If your tearing comes from overflow rather than dryness, adding plugs could increase the amount of fluid on the eye surface. A thorough exam, including the dye disappearance test and irrigation, helps confirm which category you fall into before any plug is placed.
The decision depends on the cause. Reflex tearing from dry eye almost always responds to drops, compresses, and surface treatments without any procedure. A narrow punctum can often be widened in the office under local anesthetic. A fully blocked nasolacrimal duct typically requires a DCR to achieve lasting relief, since no amount of drops will reopen a scarred channel. We will explain the finding and the expected outcomes of each option so you can make an informed choice.
LASIK temporarily reduces the density of the corneal nerves that signal tear production, which can worsen dry eye during the first few months after surgery. For some patients this leads to a period of reflex tearing before the surface stabilizes. If you already have tearing or dry eye symptoms before surgery, tell your surgeon during the consultation so the two conditions can be managed together and sequenced in the right order.
Most patients return to light activity within a few days and are back to their normal routine within one to two weeks. A small silicone tube is often left in place for several weeks after the procedure to keep the new passage open while it heals, and we remove it in the office at a follow-up visit. Nasal rinses in the weeks after surgery can help keep the opening clear and reduce the small risk of the passage narrowing again over time.
In general, yes, but some adjustments are important. Avoid eyeliner applied to the inner lid margin, since this area sits directly over the drainage openings and pigment can clog them. Replace mascara every three months and remove all eye makeup fully before bed. If you have had surgery or have an active infection at the inner corner of the eye, pause all eye makeup until your care team gives you the go-ahead to reduce the risk of introducing bacteria into a healing area.
Care for Watery Eyes at The Eye Center
Persistent tearing has a clear cause in the vast majority of patients, and that cause almost always has an effective treatment. Our ASOPRS-trained Oculoplastic Surgeon and care team at The Eye Center bring specialized expertise in the full range of eyelid and tear duct conditions, from simple in-office procedures to advanced drainage surgery, all performed within our practice in Northern Virginia. If watery eyes are affecting your daily life, we encourage you to schedule an evaluation so we can identify exactly what is happening and help you find lasting relief.