Excessive Tearing (Lacrimation)
Excessive tearing, or lacrimation, occurs when eyes produce too many tears or when tears cannot drain properly. While tears are essential for eye health, excessive watering can be bothersome and may indicate underlying eye conditions. Understanding the cause is crucial, as treatment varies from simple remedies to surgical procedures.
Quick Facts
- Common at all ages
- Multiple causes possible
- Can affect one or both eyes
- Often treatable
- May need evaluation
⚠️ Seek Immediate Medical Care If Excessive Tearing Occurs With:
- Sudden vision loss or severe vision changes
- Severe eye pain that worsens
- Eye injury or trauma
- Chemical exposure to eyes
- Signs of severe infection (pus, swelling, fever)
- Light sensitivity with severe headache
- Bulging of the eye
- Blood in tears
- Foreign object that cannot be removed
- Sudden onset with facial weakness
- Eye looks cloudy or hazy
These symptoms may indicate serious eye conditions, infections, or injuries requiring emergency treatment.
Understanding Excessive Tearing
Tears are produced by lacrimal glands located above each eye and drain through tiny openings (puncta) in the inner corners of the eyelids into the tear ducts, eventually reaching the nose. This continuous process keeps eyes moist, clear of debris, and protected from infection. When this delicate balance is disrupted, excessive tearing occurs.
Paradoxically, both overproduction of tears and dry eyes can cause excessive tearing. Dry eyes trigger reflex tearing as the eye attempts to compensate for inadequate baseline tear production. This creates a cycle of dryness followed by overflow tearing. Additionally, blocked drainage pathways force tears to overflow onto the cheeks rather than draining normally.
The impact of excessive tearing extends beyond physical discomfort. Constant wiping can irritate the delicate skin around the eyes, blurred vision can affect daily activities like reading and driving, and the social embarrassment of constantly watery eyes can affect quality of life. Identifying the underlying cause is essential for effective treatment.
Types of Excessive Tearing
Reflex Tearing
- Response to irritation
- Sudden onset
- Often temporary
- From dry eyes
- Wind or smoke
- Bright lights
- Foreign objects
- Emotional response
Blocked Drainage
- Constant tearing
- Often one eye
- Tears overflow
- May have discharge
- Swelling near nose
- Recurrent infections
- Worse in cold/wind
Overproduction
- Both eyes usually
- Clear tears
- Various triggers
- Allergies common
- Eye inflammation
- Medication effects
- Chronic conditions
Poor Lid Function
- Eyelid problems
- Ectropion (out-turning)
- Entropion (in-turning)
- Facial nerve issues
- After stroke
- Bell's palsy
- Tears don't spread
Common Causes
Eye Conditions
- Dry eye syndrome: Paradoxical tearing from irritation
- Conjunctivitis: Pink eye from infection or allergies
- Blepharitis: Eyelid inflammation
- Corneal abrasion: Scratch on eye surface
- Foreign body: Eyelash, dust, debris
- Corneal ulcer: Open sore on cornea
- Iritis/uveitis: Internal eye inflammation
- Glaucoma: Acute angle closure
Structural Problems
- Blocked tear ducts: Congenital or acquired
- Narrow tear ducts: Partial obstruction
- Ectropion: Lower lid turns outward
- Entropion: Lid turns inward
- Loose eyelids: Poor tear distribution
- Punctal stenosis: Drainage opening narrowed
- Nasal problems: Deviated septum, polyps
Irritants and Allergies
- Seasonal allergies: Pollen, grass, trees
- Environmental irritants: Smoke, pollution, wind
- Chemical exposure: Cleaners, perfumes
- Contact lens problems: Overwear, poor fit
- Eye makeup: Allergic reactions
- Eye drops: Preservative sensitivity
- Bright lights: Sun, computer screens
Systemic Conditions
- Facial nerve palsy: Bell's palsy, stroke
- Thyroid eye disease: Graves' disease
- Sjögren's syndrome: Autoimmune dry eye
- Rheumatoid arthritis: Associated dry eye
- Parkinson's disease: Reduced blinking
- Medications: Some cause tearing
- Sinus infections: Affect tear drainage
Associated Symptoms
Excessive tearing often occurs with other eye symptoms that help identify the cause:
- Eye redness: Inflammation or infection
- Eye pain: Severity indicates urgency
- Itching: Often allergic causes
- Burning sensation: Dry eye or irritation
- Discharge: Yellow/green suggests infection
- Blurred vision: From tears or condition
- Light sensitivity: Photophobia
- Foreign body sensation: Feeling something in eye
- Eyelid swelling: Infection or inflammation
- Crusting: Especially morning
- Facial pain: Sinus involvement
- Headache: Eye strain or pressure
Age-Related Considerations
Infants
- Blocked ducts common
- Usually resolves by 1 year
- Massage helps
- Sticky discharge
- One or both eyes
- May need probing
Children
- Allergies common
- Eye infections
- Foreign objects
- Blocked ducts persist
- Eye rubbing
- School vision issues
Adults
- Dry eye syndrome
- Computer use
- Contact lens issues
- Environmental factors
- Medication effects
- Stress-related
Elderly
- Lid laxity common
- Ectropion risk
- Dry eye increases
- Medication effects
- Duct stenosis
- Multiple factors
Diagnosis and Evaluation
Medical History
- Duration and pattern of tearing
- One or both eyes affected
- Associated symptoms
- Triggers identified
- Previous eye problems
- Medications
- Allergies
- Recent infections
Eye Examination
- Visual acuity testing
- External eye inspection
- Slit lamp examination
- Eyelid position assessment
- Tear film evaluation
- Corneal staining
- Drainage system check
Diagnostic Tests
- Schirmer test: Measures tear production
- Dye disappearance test: Drainage function
- Lacrimal irrigation: Checks for blockage
- Jones test: Detailed drainage assessment
- CT or MRI: For structural problems
- Cultures: If infection suspected
- Allergy testing: For allergic causes
Treatment Options
Conservative Treatment
- Warm compresses
- Gentle eye cleaning
- Artificial tears
- Avoid irritants
- Treat allergies
- Protect from wind
- Sunglasses outdoors
Medical Treatment
- Antibiotic drops/ointment
- Anti-allergy drops
- Steroid drops
- Dry eye treatments
- Punctal plugs
- Oral medications
- Treat underlying conditions
Procedures
- Tear duct probing
- Balloon dacryoplasty
- Stent placement
- Dacryocystorhinostomy (DCR)
- Eyelid surgery
- Punctoplasty
- Botox for spasm
Home Management
- Keep face clean
- Pat, don't rub eyes
- Use hypoallergenic products
- Humidify air
- Take breaks from screens
- Stay hydrated
- Manage allergies
Tear Duct Massage for Infants
Crigler Massage Technique
- Wash hands thoroughly
- Place index finger on inner corner of eye
- Apply gentle pressure
- Massage downward along nose
- Repeat 2-3 times
- Perform 2-3 times daily
- Clean any discharge gently
- Continue until resolved
Prevention Strategies
- Eye protection: Wear safety glasses when needed
- Manage allergies: Avoid triggers, take medications
- Good hygiene: Clean hands before touching eyes
- Proper contact care: Follow wearing schedule
- Screen breaks: 20-20-20 rule
- Humidify environment: Prevents dry eye
- UV protection: Quality sunglasses
- Avoid irritants: Smoke, chemicals
- Regular eye exams: Early problem detection
- Treat infections promptly: Prevents complications
- Gentle makeup removal: Avoid irritation
- Stay hydrated: Supports tear production
When to See a Doctor
Schedule an Appointment For:
- Persistent tearing lasting weeks
- Tearing interfering with vision
- Recurrent eye infections
- Discharge with tearing
- Eyelid position changes
- Failed home treatments
- Infant tearing past 12 months
Seek Immediate Care For:
- Severe eye pain
- Vision loss or changes
- Eye injury
- Chemical in eye
- Signs of severe infection
- Light sensitivity with headache
- Blood in tears
- Eye appears cloudy