Watery eyes (epiphora): UK causes, symptoms and treatment

Constant or intermittent watery eyes — known as epiphora — is one of the commonest complaints I see in clinic. It is rarely dangerous but can be miserable, blurring vision, streaking make-up and forcing patients to carry tissues. This UK-focused guide explains why the eyes water and how each cause is treated.

The paradox: dry eye causes watery eyes

The commonest cause of watering eyes in UK adults is, counter-intuitively, **evaporative dry eye disease**. When the tear film becomes unstable, the surface of the eye becomes irritated. The lacrimal gland responds by producing a flood of low-quality reflex tears, which overflow onto the cheek. The eye feels 'wet' but is not properly lubricated.

Treatment focuses on the tear film itself: preservative-free lubricants, warm compresses and lid hygiene for blepharitis, omega-3 supplementation, and sometimes prescription anti-inflammatory drops. See our related guide on blepharitis.

Blocked or narrowed tear ducts (naso-lacrimal duct obstruction)

The tear-drainage system runs from the inner corner of each eyelid down into the nose. Any narrowing or blockage along the route causes tears to back up onto the cheek. In UK adults over 50, involutional stenosis of the naso-lacrimal duct is common — the pipework simply narrows with age.

Signs pointing to a blockage:

- Watering that is worse outdoors, in wind or cold

- A wet lower eyelid at rest

- Recurrent sticky eye or infections of the tear sac (dacryocystitis)

- A small lump at the inner corner of the eye

The definitive test is syringing and probing of the ducts, performed under local anaesthetic. If a blockage is confirmed, the treatment is a **dacryocystorhinostomy (DCR)** — a small operation that creates a new drainage pathway from the tear sac into the nose. Success rates are 90–95%.

Eyelid problems

The lower eyelid has to sit snugly against the eye to sweep tears towards the drainage points at the inner corner. When the lid position is wrong, tears pool and overflow. Common eyelid causes include:

- **Ectropion** — lid rolls outward, exposing the pink inner surface

- **Entropion** — lid rolls inward, so lashes rub the eye

- **Facial nerve weakness** (post-Bell's palsy) leaving the lid slack

- **Floppy eyelid syndrome**

All of these are treated by a straightforward oculoplastic day-case operation to reposition the lid.

Allergy and irritation

Hay fever, dust mite allergy and pet allergy provoke tear flow via histamine release. UK pollen counts peak from May to July, and antihistamine drops (sodium cromoglicate, olopatadine) settle the eyes quickly. Occupational irritants — welding fumes, cleaning chemicals, chlorinated pool water — cause the same response.

Corneal problems

A scratch, a lodged foreign body, contact-lens over-wear, viral keratitis or a corneal ulcer will all trigger reflex watering. These are typically painful and light-sensitive and should be assessed the same day at an eye A&E.

When watery eyes need urgent review

Attend an eye casualty the same day if watering is accompanied by:

- Sudden pain, redness or light sensitivity

- Sudden loss of vision or a curtain across the vision

- A visible cut, burn or foreign body

- Purulent (yellow-green) discharge with fever, in a baby under three months

How the cause is diagnosed

In a private consultation I would typically:

- Take a detailed history (timing, triggers, discharge, past surgery)

- Examine the tear film and measure tear break-up time

- Examine the lids for position, lash direction, meibomian gland disease

- Perform a fluorescein disappearance test to check drainage

- If required, syringe the tear ducts to identify a mechanical block

This ninety-minute assessment identifies the cause in over 95% of adults.

Next steps

If you have persistent watery eyes and want a definitive diagnosis and a treatment plan in a single visit, you can book a private consultation or call **020 3137 3237**. For more on our full range of assessments, see medical ophthalmology.