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What is Epiphora and How to Manage it

What is Epiphora and How to Manage it

February 13, 2024

What is Epiphora?

Epiphora, commonly known as watery eyes, is a condition characterized by an excessive tear production or insufficient tear drainage. It is a prevalent issue that affects individuals of all ages, though it is more common in newborns and the elderly. The balance between tear production and drainage is crucial for eye health, as tears provide nourishment and protection to the eye's surface. Any disruption in this balance can lead to watery eyes.

Causes of Epiphora

Several factors can lead to epiphora, including:

Blocked Tear Ducts: Nasolacrimal duct obstruction is a primary cause, preventing tears from draining normally.

Allergies: Can cause inflammation and increased tear production.

Blepharitis: Inflammation of the eyelid edges, affecting tear quality and evaporation.

Dry Eyes: Paradoxically leads to excessive tear production as a compensatory mechanism.

Styes and Chalazions: Infections or blockages of the eyelid glands can interfere with tear drainage.

Entropion: The inward turning of the eyelid irritates the eye and increases tear production.

Eye Injuries: Trauma to the eye or surrounding structures can disrupt the normal tear drainage process.

Epiphora causes

Signs and Symptoms of Epiphora

The symptoms of epiphora extend beyond mere excessive tearing and can significantly impact an individual's quality of life. Understanding these symptoms in detail can help in identifying the condition early and seeking appropriate treatment.

1. Excessive Tearing: The most noticeable symptom of epiphora is an abnormal overflow of tears, which may occur continuously or intermittently. This can lead to discomfort and even social embarrassment, as tears can stream down the face without emotional provocation.

2. Eye Discomfort: Individuals with epiphora often report a range of discomforting sensations in the eyes, including a burning or stinging sensation, itchiness, and a feeling as if something is in the eye (foreign body sensation). These symptoms are not only irritating but can also interfere with daily activities.

3. Redness and Irritation: The constant presence of excessive tears can lead to redness and irritation of both the eye and the surrounding skin. The skin around the eyes may become sore or inflamed from the persistent moisture, which can exacerbate skin conditions such as eczema.

4. Blurred Vision: The surplus of tears can cause temporary blurring of vision, making it difficult to focus on tasks. This can be particularly challenging for activities that require sharp visual acuity, such as reading or driving.

5. Light Sensitivity: Individuals with epiphora may experience increased sensitivity to light, a condition known as photophobia. This can be due to the underlying causes of Epiphora, such as inflammation or infection, which can make bright lights uncomfortable or even painful.

6. Mucous Discharge: In some cases, epiphora can be accompanied by a mucous discharge, which may be clear or slightly colored. This can result from the irritation of the eye's surface and may lead to the eyes feeling "sticky" upon waking or after prolonged periods of closure.

7. Eyelid Skin Changes: Chronic epiphora can lead to dermatological changes in the skin around the eyes. Prolonged exposure to moisture can cause the skin to become macerated (softened and broken down), which may lead to infection or dermatitis.

8. Impact on Daily Life: Beyond the physical symptoms, epiphora can have a significant impact on daily life, affecting activities such as reading, driving, and computer work. The constant need to wipe away tears can be distracting and may hinder professional and social interactions.

Epiphora Diagnosis

Diagnosing epiphora involves a series of evaluations and tests to determine the cause of excessive tearing and the most appropriate treatment plan. The diagnostic process is thorough, aiming to assess not only the symptoms but also the underlying conditions contributing to the disorder.

Patient History: The first step involves a detailed discussion of the patient's medical history, symptoms, and any related factors, such as environmental allergens, use of medications, or previous eye conditions. This helps in identifying potential triggers or contributing factors to epiphora.

Ophthalmological Examination: A comprehensive eye examination is conducted to evaluate the overall health of the eyes. This includes assessing the eyelids, cornea, conjunctiva, and tear ducts. Special attention is given to the eyelid structure, tear film, and the functioning of the lacrimal (tear-producing) and meibomian (oil-secreting) glands.

Dye Test: The dye test, also known as the fluorescein dye test, involves placing a small amount of dye into the eye. This helps visualize the flow of tears and can reveal blockages in the tear drainage system. The dye test can also help in identifying any abrasions on the cornea.

Schirmer Test: This test measures tear production by placing a thin strip of filter paper under the lower eyelid. After a few minutes, the amount of wetting on the paper is measured, indicating whether the tear production is within the normal range.

Jones Test: This test assesses the patency (openness) of the tear drainage system. It involves placing a dye in the eye and observing whether it passes into the nose, which would indicate a functioning nasolacrimal duct.

Imaging Tests: In some cases, imaging studies such as a dacryocystogram (DCG) or a magnetic resonance imaging (MRI) scan may be recommended to visualize the tear ducts and surrounding structures. These tests can help identify blockages or structural abnormalities.

How to Treat Epiphora

The treatment of epiphora varies depending on the underlying cause and severity of symptoms. A multifaceted approach may be employed, combining lifestyle modifications, medical treatments, and, in some cases, surgical interventions.

1. Conservative Measures: Initial treatment often involves conservative measures such as the use of artificial tears for lubrication, warm compresses to relieve eyelid inflammation, and gentle eyelid cleaning to reduce irritation. Managing environmental factors, such as avoiding wind and dust, can also help minimize symptoms.

2. Medical Interventions: For cases related to infections or inflammation, antibiotic or anti-inflammatory eye drops may be prescribed. If allergies are a contributing factor, antihistamine or mast cell stabilizer eye drops can be effective. For those with dry eye syndrome leading to reflex tearing, treatments aimed at improving tear quality and reducing inflammation may be recommended.

3. Punctal Plugs: In cases where tear drainage is too rapid, punctal plugs may be inserted into the tear ducts to slow down tear drainage, thereby keeping the eyes more lubricated.

4. Surgical Options: Surgery may be considered for patients with structural problems or persistent blockages that do not respond to other treatments. Procedures may include dacryocystorhinostomy (DCR), where a new drainage path is created between the tear sac and the nasal cavity, or balloon catheter dilation, which widens the tear ducts to improve drainage.

5. Laser Treatments: For specific conditions, such as certain types of eyelid malpositions, laser treatments may be used to correct the underlying issue without the need for more invasive surgery.

Lifestyle Tips and Follow-up Care

Managing Epiphora effectively extends beyond medical or surgical treatments. Incorporating certain lifestyle adjustments can greatly alleviate symptoms and improve the quality of life. Here are detailed lifestyle tips along with the importance of follow-up care:

● Eyelid Hygiene: Regularly cleaning the eyelids can help remove debris and reduce the risk of infections that might exacerbate Epiphora. Use a warm, damp cloth to gently wipe the eyelids. Special eyelid cleansers may be recommended for conditions like blepharitis. Check out our in-depth guide on Eyelid Hygiene: Preventing Common Eye Conditions.

● Environmental Adjustments: Protecting the eyes from irritants such as smoke, dust, and strong winds can prevent exacerbation of symptoms. When outdoors, wearing sunglasses or protective eyewear can help shield the eyes from environmental factors.

● Humid Environment: Using a humidifier, especially in dry climates or during winter months, can help maintain moisture levels in the air, preventing dry eyes and compensatory tearing.

● Dietary Considerations: A diet rich in omega-3 fatty acids, found in fish, flaxseeds, and walnuts, can improve tear quality and reduce dry eye symptoms. Staying hydrated by drinking plenty of water is also beneficial.

● Screen Time Management: Reducing screen time and taking regular breaks can help alleviate eye strain and dryness, common triggers for excessive tearing. The 20-20-20 rule, where every 20 minutes, you look at something 20 feet away for at least 20 seconds, can be particularly helpful.

● Follow-up Care: Consistent follow-up appointments are essential for monitoring the condition and adapting treatment plans as needed. These appointments provide an opportunity to discuss any changes in symptoms, effectiveness of treatments, and to conduct regular assessments of eye health.

● Adaptations for Daily Activities: For those whose vision is affected by Epiphora, adjustments may be needed for activities that require sharp focus, such as driving or reading. Positioning screens to reduce glare and using adequate lighting can help minimize visual disturbances.

When to Seek Medical Attention

While many cases of Epiphora can be managed with the above measures, certain situations require immediate medical attention:

Sudden Onset of Symptoms: A sudden increase in tearing, especially if accompanied by pain or vision loss, can indicate an acute condition such as an eye infection or injury.

Signs of Infection: Symptoms such as pus or thick discharge, severe redness, or swelling around the eyes signify an infection that needs prompt treatment.

Impact on Vision: If excessive tearing is significantly affecting your ability to see clearly, it's crucial to consult an eye care professional to prevent potential long-term damage.

Unresponsive to Treatment: If symptoms persist despite following treatment and lifestyle recommendations, further evaluation may be necessary to identify underlying causes that have not been addressed.

New Symptoms: Development of new symptoms, such as light sensitivity, pain, or the sensation of a foreign body in the eye, warrants a reevaluation by a healthcare provider.


Epiphora, or watery eyes, is a condition that, while often manageable, can significantly impact one's daily life and eye health if left untreated. It arises from a variety of causes, ranging from blocked tear ducts and allergies to more complex issues such as eyelid disorders and systemic conditions. The symptoms associated with Epiphora extend beyond simple tear overflow, affecting vision quality, comfort, and even social interactions due to the constant need to address tearfulness and related discomforts.

Lifestyle modifications, including environmental adjustments and dietary considerations, play a crucial role in managing symptoms and preventing exacerbations. Moreover, the emphasis on regular follow-up care cannot be overstated, as it ensures ongoing monitoring, timely adjustments in treatment, and the prevention of potential complications.

The decision to seek medical attention when symptoms persist, worsen, or impact one's quality of life is pivotal. Regular eye examinations are recommended not only for those experiencing symptoms of Epiphora but also as a preventive measure to maintain overall eye health.

This comprehensive approach to understanding, diagnosing, and treating Epiphora underscores the importance of early intervention and the effectiveness of a personalized care plan. Individuals experiencing persistent watery eyes are encouraged to consult with healthcare professionals to explore their treatment options. By doing so, they can achieve relief from symptoms, enhance their quality of life, and safeguard their vision for the future.


What is epiphora?
Epiphora refers to excessive tearing or watering of the eyes, often due to an overproduction of tears or inadequate drainage.
What causes epiphora?
Epiphora can be caused by various factors including blocked tear ducts, eye infections, allergies, dry eyes, eyelid problems, inflammation, or structural abnormalities in the eye.
What are the symptoms of epiphora?
Symptoms may include constant tearing, blurred vision, eye irritation, redness, or sticky discharge from the eyes.
Can epiphora be treated?
Yes, treatment depends on the underlying cause. It may include medications such as antibiotics or anti-inflammatory drugs, tear duct irrigation, punctal plugs to block tear drainage, or surgical procedures to correct structural abnormalities.
Is epiphora a serious condition?
Epiphora itself is not typically serious, but it can be bothersome and affect quality of life. However, it can sometimes be a sign of an underlying eye or systemic condition that requires medical attention.
Are there home remedies for epiphora?
While home remedies may provide temporary relief, they do not address the underlying cause of epiphora. However, practicing good eye hygiene, using warm compresses, and avoiding known allergens may help alleviate symptoms.