Watery Eyes – Why It Happens, What Helps and When to See a Doctor

An eye that keeps watering is a common and irritating complaint: tears run down the cheek, blur the vision, smudge make-up and keep a tissue permanently in your pocket. In most cases it is not dangerous, but to treat it properly you first need to understand which side the problem comes from – is the eye producing too many tears, or are the tears not draining as they should? This page explains both directions, what you can do at home, and when you should be examined.

How tears are made and where they go

Tears are produced all the time in small amounts, and coat the eye surface in a thin layer that protects it and allows sharp vision. With every blink the eyelids spread the tears and push them towards the inner corner of the eye, next to the nose. There are two tiny openings there, one at the edge of the upper eyelid and one at the edge of the lower. From them the tears pass through thin channels into the tear sac, and from there through the tear duct into the nose. That is why your nose also “runs” when you cry.

A watery eye is the result of an imbalance between the two sides of this system: too many tears coming in, or too few tears going out.

The first cause: the eye is irritated and produces more tears

When the eye surface is irritated, the eye responds with a flood of tears to wash the irritation away. This is the most common cause of watery eyes, and it usually affects both eyes. The main triggers:

• Dry eye – it sounds strange, but this is one of the most common causes of watery eyes. The normal tear film is unstable, the eye dries out and responds with watery tears that do not last. The watering usually gets worse in front of a screen, in air conditioning, in the wind and when reading.
• Eyelid inflammation – blepharitis and problems with the glands at the eyelid margin damage the oily layer of the tears, causing burning, red lid margins and watering.
• Allergy – itching in both eyes, redness and watering, sometimes with a runny nose and sneezing. More on this in eye allergy.
• A foreign body or a scratch – a speck of grit, an eyelash or a corneal abrasion cause heavy watering in one eye, with a “something in my eye” feeling and pain.
• Eyelashes that turn inwards, or an eyelid that turns in and rubs against the eye surface.
• Conjunctivitis – a red eye with discharge, usually viral.
• Wind, cold and smoke – watering outdoors on a cold, windy day is a normal reaction of the eye, not a sign of disease.

The second cause: the tears do not drain

Here the eye produces a normal amount of tears, but the way out is blocked or not working well. The tears collect along the lower eyelid and run down the cheek, even indoors and without any irritation, and often more in one eye than the other. The main causes:

• A change in the position of the lower eyelid – with age the lower eyelid can become lax and move away from the eye, so that the drainage opening is no longer “dipped” in the tears. An eyelid that turns outwards or inwards also disrupts drainage.
• Narrowing of the drainage opening – the tiny opening at the inner corner becomes too narrow, sometimes as a result of chronic eyelid inflammation.
• A blocked tear duct – more common with age. A typical sign is sticky discharge or mucus coming from the inner corner, especially in the morning or when you press on the area next to the nose.
• Weakness of the facial nerve – for example in Bell’s palsy, when the eyelids do not close well and blinking does not “pump” the tears away.
• Other factors – injury to the nose and eye area, previous nose and sinus surgery, and certain medicines, including some cancer treatments.

What you can do at home

When the watering is mild, in both eyes and without pain, a few simple steps often help:

• Preservative-free lubricating drops – precisely when the eye waters. If the watering comes from dryness, a stable tear film reduces the irritation and the flooding.
• Warm compresses and gentle cleaning of the eyelid margins – when there is eyelid inflammation or blocked glands.
• Protection from wind – sunglasses outdoors, and directing the air-conditioning flow away from your face.
• Do not rub – rubbing increases the irritation and the watering, especially in allergy.
• Do not use “whitening” drops, and do not use antibiotic or steroid drops without an examination – they do not treat the cause, and some may cause harm.

If the watering does not improve after two to three weeks, if it is in one eye only, or if it interferes with reading, driving or working, it is worth being examined.

What is checked in the clinic

The examination starts with questions: is the watering in one eye or both, does it get worse in the wind or also indoors, is there discharge, itching or burning? Then, under the microscope (slit lamp), the ophthalmologist checks:

• the tear film and the corneal surface, including signs of dryness and scratches;
• the eyelid margins, the lashes and the eyelid glands;
• the position of the eyelids and the drainage openings at the inner corner.

When a drainage problem is suspected, a yellow dye (fluorescein) can be put into the eye to check after a few minutes whether it has drained or stayed in the eye. Another test is a gentle rinse of the tear passages with saline through the drainage opening: when the system is open, the patient feels the fluid in the nose or throat. Depending on the findings, a nose examination by an ear, nose and throat specialist or an imaging test is sometimes also needed.

Treatment according to the cause

The treatment depends on what the examination found:

• Irritation of the eye surface – treatment of dryness and eyelid inflammation, allergy drops when allergy is the cause, removal of an eyelash or foreign body. In most cases the watering lessens once the eye surface settles.
• A problem with eyelid position – a small operation that returns the eyelid to its place.
• A blocked tear duct – when the blockage causes troublesome watering or repeated infections, the treatment is an operation that creates a new passage from the tear sac into the nose (DCR). The operation is done through a small skin incision or through the nose, by surgeons who specialise in the eyelids and tear passages, sometimes together with an ear, nose and throat surgeon.

Eyelid and tear-duct operations are not performed at Prof. Mimouni’s clinic. When the examination shows that the problem is in the drainage, the patient is referred to a surgeon who specialises in this field.

Watery eyes in babies

A baby with one eye that has watered since the first weeks of life, with sticky lashes in the morning but a white, quiet eye, usually has a congenital blockage of the tear duct: a thin membrane at the end of the duct, inside the nose, has not yet opened. This is a common condition, and in most cases it clears up on its own by the age of one. The ophthalmologist or the paediatrician can demonstrate a gentle massage of the area between the eye and the nose. When the blockage persists, opening the duct with a fine probe is considered.

Situations in a baby with a watery eye that need an urgent examination:

• sensitivity to light, squeezing the eyes shut in light, eyes that look larger than usual, or a cloudy cornea – signs that may point to congenital glaucoma;
• redness and swelling at the inner corner of the eye;
• a baby in the first month of life with a red eye and discharge.

When to seek urgent care

Watering on its own is almost never an emergency. It does need an examination the same day when it comes with:

• a red, painful swelling at the inner corner of the eye, next to the nose – a sign of infection of the tear sac, which needs prompt treatment;
• severe eye pain, a red and painful eye, or strong sensitivity to light;
• reduced vision;
• an eye injury or a chemical splash – rinse immediately with water and seek care.

Blood-stained tears, or a lump felt near the inner corner of the eye, justify an examination soon. For the difference between situations that need the emergency room, a same-day examination or a regular appointment, see urgent eye problems. And if the eye is also red, it is worth reading red eyes.

When to be examined by Prof. Michael Mimouni

Prof. Michael Mimouni, Director of the Cornea Unit at Rambam, sees patients at his clinics in Herzliya Pituach and Haifa with watering that comes from the eye surface – dryness, eyelid inflammation, allergy, corneal problems and lashes that rub against the eye. The examination clarifies whether the problem is excess tears or poor drainage, and what the next step is – treatment in the clinic or referral to an eyelid and tear-duct surgeon. It is worth booking an examination when the watering lasts more than two to three weeks, when it is in one eye, when there is recurrent discharge from the inner corner, or when it interferes with daily life. Contact the clinic to book an examination.

The information on this page is general and is not a substitute for an examination and personal medical advice. Diagnosis and treatment decisions are made only after a full eye examination. With a red, painful swelling near the inner corner of the eye, severe pain or reduced vision – seek an examination the same day.