What Causes Watery Eyes and How to Manage It?

A bout of watery eyes affects all of us at some point, whether it’s from chopping onions or because a little bug flew into your eye. However, sometimes watery eyes can suddenly come upon us for no identifiable reason – in these cases, how do you know whether it’s an eye health problem necessitating oculoplastic surgery or something that can just be ignored? Apart from the obvious, what causes watery eyes and how can you manage it? 

What Causes Watery Eyes?

The medical term for watery eyes is epiphora. Although unexpectedly teary eyes can be an inconvenience, epiphora is not typically an eye health concern, though it may be bothersome enough for some to seek oculoplastic surgery. 

Watery eyes are often a reflexive response to something that has caused irritation to the sensitive cornea of the eye. This can be due to chemical irritation, such as cleaning chemical fumes or chopped onions, or physical irritation, like an eyelash in the eye or accidentally brushing against the cornea with your finger. Reflexive tearing is an important reaction as the increased tear production helps to wash away any foreign particles and re-lubricate the surface of the eye. 

Other causes of watery eyes can be due to compromised eye health, such as from eye infections or allergies. If you’ve ever had conjunctivitis, keratitis (inflammation of the cornea), or hayfever, you’ll know that these conditions are among the common reasons of what causes watery eyes. Typically, these causes are easily identifiable as they are associated with other signs and symptoms, such as itching, discharge from the eye, and a red eye. Treating the underlying condition, such as with antibiotic or antihistamine eye drops, will help the epiphora to resolve as the infection or allergy clears.

An unexpected cause of watery eyes can be dry eyes. Although counterintuitive, when the surface of the eye is dry, this produces a reflexive reaction to increase tear production from the lacrimal gland. For good eye health and optimal vision, the surface of the eye needs to stay well lubricated with a stable layer of tears. Dry eyes occur when this tear film is thinned or uneven, or simply evaporates too rapidly between blinks. Though it may seem unusual to be adding more moisture into an already watery eye, treating the dry eye condition with lubricant eye drops can often help to remove the stimulation for the eye to produce reflexive tears. Other dry eye therapies such as warm compresses or intense pulsed light treatment can also help if dryness is the underlying cause of the tearing. 

Along with dry eyes, changes to the nasolacrimal system and eyelids can be the most difficult to identify as an underlying reason for what causes watery eyes. The nasolacrimal system and eyelids play a big part in draining away tears from the surface of the eye. With each blink, a properly functioning pair of eyelids pushes tears pooling along the margin of the bottom eyelid towards two tiny openings at the inner corners of each eye, known as puncta. Assuming the nasolacrimal system is open and unobstructed, tears can then drain through these apertures, down the nasolacrimal duct and eventually down the back of the throat. However, age, trauma, and disease can affect the effectiveness of the eyelids and nasolacrimal system at draining away tears, resulting in epiphora. Oculoplastic surgery may be the only effective treatment for such causes of watery eyes. 

Oculoplastic Surgery for Watery Eyes

Oculoplastics refers to a subspeciality of ophthalmology focused on the structures around the eyes, including the eyelids, eye socket, nasolacrimal system, and nearby facial anatomy. An oculoplastics eye surgeon can address epiphora via a number of surgical and non-surgical methods, depending on the underlying cause.

Obstruction or narrowing of the puncta is not uncommon with age, impeding the passage of tears through these apertures. In some minor cases, stretching these openings in a non-surgical procedure known as punctal dilation may be sufficient, however, if the puncta are quite narrow or quickly revert back to their narrowed state, the insertion of a stent or a small operation called punctoplasty may be necessary to widen the puncta. If there is narrowing of the lacrimal ducts beyond the puncta, a dacryocystorhinostomy is a procedure used to create a new drainage channel between the eye and the nose. 

A blocked nasolacrimal system can also be caused by an abnormal growth, either cancerous or benign. As part of an investigation into epiphora, the eye surgeon will be able to determine if this is the case and operate appropriately if necessary.  

Various dysfunctions of the eyelids may contribute to poor drainage of tears and resultant watery eyes. This includes the lower eyelid becoming loose with age and flopping away from the eye (ectropion) or a weak blink, such as from Bell’s palsy and facial nerve paralysis. Treatment by an oculoplastics specialist may include an ectropion repair, tightening the lower eyelid such that it sits against the eye properly, or the insertion of small gold weights into the upper eyelid to help it close fully with each blink. If there are any bumps along the lower eyelid margin that may be disrupting the flow of tears, these can be surgically removed. 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

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