Cry Me A River

Patients often come to my clinic complaining of watery eyes, also called epiphoria. This can cause them problems from just a mere nuisance of looking upset all the time, to chronic irritation of the surrounding eyelid skin, and can even cause visual distortion. There are multiple causes of watery eyes and it is important to have a complete evaluation of the ocular and lacrimal system to help decide what is the cause.


On of the most common causes of epiphoria is dry eyes. Patients will come in complaining of watery eyes and work up will reveal an underlying dry eye problem. This often becomes more common as we get older, change medications, hormonal changes, eyelid changes or even change in the weather since colder air is actually drier air. Any one or a combination of these can cause the common signs of dry eyes (scratchy, painful eyes) but they can also cause the eye to water. This is one of most common first line treatments for watery eyes, often with the eye doctor recommending the use of an artificial tear drop. I  often see patients come in with epiphoria complaints that have been treated for dry eyes but have not improved. The problem is not all watering is dryness and not all doctors know how to tell the difference. There are certain test and stains that can be done in the office to determine if there is dryness or not. My favorite and most useful is a dye called lissamine green. It is very easy to see dryness on the lids, conjunctiva and cornea as it stains it a vibrant green color. There is not much debate with this stain of the eyes being dry or not. If there is dryness seen then there are multiple treatments available which will be discussed in a later article.

Lacrimal drainage problem

So if dry eyes are not the problem other areas must be examined (and should be examined even with dry eyes to ensure no other problems). I tell patients the best way to think of the lacrimal system is remember all it is plumbing. There is a drain opening in the corner of the eyelid on both the upper and lower lids, called the punctum. This is like the opening of the drain in your sink. From this tears flow through progressively increasing larger pipe that carry the water from the eye to the nose where it then goes down to throat. So one are that needs to be checked with a complaint of watery eyes is are the pipes clogged up? This is a simple procedure in the office of flushing some water through the system and see if it flows freely. Patients tell me they feel some pressure but not pain so it is a well tolerated test. If there is blockage of the tear duct then often a surgical procedure called a dacryocystorhinostomy or DCR. This is done to create a new pathway for the tears to flow into the nose. The surgery can be done with an incision through the eyelid skin or through the nose with endoscopic instruments. This is an outpatient procedure that patients have very little down time from the surgery.


These are a few of the possible causes of watery eyes. It covers the more common reason but there are many other causes that need to be evaluated and possible treated by a qualified oculoplastic doctor.


Jody Abrams, MD


Sarasota Retina Institute 

Sarasota, Florida

Jody Abrams, MD, FACS
Sarasota Retina Institute
Sarasota, Florida 34239


  1. […] eye and tearing are not a natural part of growing older.  They are conditions that are treatable when diagnosed […]

  2. […] study I did in my Michigan practice nearly 60% of patients walking into the office had significant lissamine green staining of their eyes or inner eyelids.  Many common medications and diseases may exacerbate or cause dry […]