An operation can cure a blocked tear duct. Other treatments depend on the cause. Watering eye is when tears overflow and run down the cheek for no apparent reason. It's caused by too many tears or tears that aren't draining away properly.

Watering eyes problem

Watering eyes (tears rolling onto your cheeks) can occur at any age, but is most common in young babies and in people over the age of 60. It can occur in one or both eyes.

Symptoms of watering eyes

Producing tears without cause, for example, when you're not upset or emotional, is the main symptom of watering eyes. You may only have the odd trickle down your cheek or tears may start rolling down your face. Other symptoms may include:

• your eyes watering more when you're outside in the wind or cold weather
• mucus, crusting or a sticky feeling in your eye
• pain or swelling at the inner corner of your eye near the bridge of your nose
• red and sore eyelid edges
  

What are the possible causes of watering eyes?

Making too many tears

Emotion can make you cry.
Anything that irritates the eye can cause you to make a lot of tears. The watering is a protective reflex to help clear irritants away from the eye. For example:

• Chemical irritants such as onions, fumes, etc.
• Infection of the front of the eye (infective conjunctivitis).
• An allergy causing inflammation of the front of the eye (allergic conjunctivitis).
• A small injury or scratch to the front of the eye, or a piece of dirt or grit which gets stuck in the eye.
• Eyelashes that grow 'inwards' can irritate the front of the eye. This is called an entropion. (See separate leaflet called 'Entropion'.)
• Abnormalities of the tear film. For example, the lipid (fat) content of tears may not be right. The tear film may then not spread evenly across the front of the eye. This may cause patches of dryness to develop, which can become sore and make your eyes water.
• Thyroid eye disease is an uncommon cause.
• Faulty drainage of tears

Tears may become blocked at any point in the drainage channels.
The most common cause of watering eye in adults is a blockage in the tear duct just below the tear sac. This is thought to be due to a gradual narrowing of the upper end of the tear duct, perhaps caused by persistent mild inflammation. If you have a blocked tear duct, not only will you have watering eyes, but the stagnant tears within the tear sac may become infected.

If the tear sac gets infected you will also have a sticky discharge on the eye. You may also develop a painful swelling on the side of the nose next to the eye.

Sometimes the tear duct is not blocked fully, but is too narrow to drain all the tears.

Less commonly there may be a blockage within the canaliculi, or the entrance to the canaliculi in the inner corner of the eye may be blocked. This may be due to inflammation or scarring.

Rarely, a polyp in the nose may block the tears from coming out of the tear duct.
Some babies are born with a tear duct which has not fully opened. This is common and usually clears within a few weeks without any treatment as the tear duct opens fully.

Ectropion. This is where the lower eyelid turns outward away from the eye. The ectropion may cause tears to roll off the bottom of the eyelid rather than drain down the canaliculi to the tear sac. See a separate leaflet called 'Ectropion'.

If a drainage problem is suspected, an eye specialist may examine the tear drainage channels under local anaesthetic. They may push a thin probe (stick) into the canaliculi towards the tear sac to see if they are blocked. If the probe goes as far as the tear sac then fluid can be syringed into the tear duct to see if it comes out in the nose.

Syringing may sometimes clear a blockage, but it may only give temporary relief. If there seems to be a blockage then a dye may be injected into the tear duct. An x-ray picture is then taken. You can see the dye in the duct on the x-ray film. It will show exactly where there is any obstruction or narrowing of the tear duct.

What is the treatment for watering eyes?

The type of treatment you have will depend on what is causing your eye to water. If your symptoms are mild, you may not need any treatment. Babies that are born with blocked tear ducts may not need any treatment.

• Self-help

Keep the area around your eye and eyelids clean and clear of any crusting or stickiness. Using a hot compress can help to ease your symptoms. Put a warm compress over your eyelid for a few minutes. Use a towel soaked in hot water to make the compress. The water you use shouldn't be scalding hot - the compress should feel comfortable on your skin.

• Medicines

If you have a mild infection, your GP may prescribe antibiotic eye drops or ointment. If your infection is more severe, your GP may prescribe antibiotic tablets. Dry eyes may need to be treated with artificial tears to keep the surface of the eye healthy - this will stop excessive tears from being formed and your eye from watering.

• Punctal dilation

This procedure can be used to open up and clear any narrowing of the tear duct openings in your eyelids. Your ophthalmologist will put a few drops of a local anaesthetic into your eye to numb the area. He or she will then use a fine stainless steel pointed instrument to open up the openings of your tear ducts in your eyelids. Local anaesthetic completely blocks feeling from your eye area and you will stay awake during the procedure.

• Lacrimal syringing

Sometimes the blockage is further down in your tear duct. Lacrimal syringing can be used to help determine where the blockage is. This is carried out under local anaesthesia. A local anaesthetic completely blocks feeling from your eye area and you will stay awake during the procedure. Your ophthalmologist may put some harmless yellow dye into your eye before syringing - this can help him or her decide whether the tear ducts are blocked.

Your doctor will put a very thin metal tube into your tear duct. This is connected to a syringe of salt water. He or she will wash the salt water through your tear duct to help remove the blockage or determine its location. When your doctor is doing this you may be able to taste salt in your mouth or feel it in your nose.

• Surgery

If your tear ducts are blocked and other treatments don't work, you may be offered surgery to unblock the ducts and widen the tear duct opening your nose. The operation is called a dacryocystorhinostomy, or DCR. You may need to have special X-rays of the tear ducts before your surgery to help establish exactly where the blockage is and whether the surgery is likely to work.

A DCR operation can be done in two different ways. Your surgeon can get to your tear duct by going up through your nose using special instruments, or he or she can make a cut in the skin at the side of your nose.