Watery Eyes and Dry Eye: Understanding Epiphora and Your Treatment Options
What Are Epiphora and Dry Eye?
Both conditions involve problems with the tear system, but they affect it in different ways. Understanding each one helps explain why a proper diagnosis is so important before starting treatment.
Epiphora is the medical term for ongoing, excessive tearing that overflows from the eyes even when you are not crying or upset. It can be caused by a blocked or malfunctioning tear drainage system, or by your eyes producing too many tears in response to irritation.
Common signs include tears running down your cheeks throughout the day, blurry vision, redness of the skin around your eyes, and soreness from frequent wiping. When left untreated, chronic epiphora can also raise the risk of eye infections such as blepharitis (inflammation of the eyelid margins) and conjunctivitis (pink eye).
Dry eye disease occurs when your eyes do not produce enough tears, or when the tears you produce evaporate too quickly to keep the eye surface properly coated. It is one of the most common reasons patients visit an eye doctor, and it tends to become more frequent with age.
Symptoms often include a scratchy or gritty feeling, burning, stinging, sensitivity to light, and difficulty wearing contact lenses or working on screens for extended periods. The condition ranges from mild and occasional to chronic and disruptive.
It may seem surprising, but dry eyes frequently trigger excess tearing. When the eye surface becomes irritated from dryness, your nervous system responds by producing a flood of reflex tears to protect it.
The problem is that these emergency tears are mostly water and lack the balanced mix of oils and proteins found in healthy tears. They do not stay on the eye surface long enough to provide real relief, which keeps the cycle of dryness and overflow going. Treating the underlying dryness is often the key to resolving the tearing as well.
Common Causes and Risk Factors
Both epiphora and dry eye can have multiple contributing causes, and in many patients more than one factor is involved. Identifying the specific cause in your case allows your eye doctor to design a treatment plan that targets the real source of the problem rather than just the symptoms.
Your tear ducts are small channels that carry tears from your eyes down toward your nose. When these become partially or fully blocked, tears have nowhere to drain and spill over onto your face.
Blockages can develop from infections, injuries, age-related narrowing, thick mucus, or long-term use of certain eye drops. Some patients are born with naturally narrow ducts, while others develop problems over time from sinus issues or prior eye procedures.
Your eyelids play a critical role in spreading tears evenly and directing them toward the drainage openings. When an eyelid turns inward, a condition called entropion, the lashes can rub against the eye and cause ongoing irritation. When an eyelid turns outward, called ectropion, tears cannot reach the drainage points and overflow instead.
These changes in eyelid position become more common with age as the supporting muscles and tissues gradually weaken. Our oculoplastic surgeon, Dr. R. Jeffrey Hofmann, M.D., works with our dry eye team to address eyelid-related causes of tearing and dryness.
Your surroundings have a significant effect on your tear film. Air conditioning, indoor heating, fans, and windy or dry weather can all accelerate tear evaporation faster than your eyes can replenish it.
Prolonged screen use, reading, and other focused tasks reduce how often you blink, which means your tear film is not refreshed as frequently as it should be. Smoke, dust, airborne chemicals, and air pollution are also common irritants that can trigger both dryness and reflex tearing.
Tear production naturally decreases as you age, and the balance of water, oils, and proteins in your tears can shift over time. Hormonal changes, particularly during menopause, can significantly reduce tear production in women.
Certain health conditions also affect the tear system, including rheumatoid arthritis, Sjogren's syndrome (an autoimmune condition that attacks moisture-producing glands), diabetes, and thyroid disorders. Many commonly prescribed medications, including antihistamines, blood pressure drugs, antidepressants, and sleep aids, can also reduce tear production as a side effect.
How We Evaluate Your Tear System
A thorough examination is the foundation of effective treatment. Our team uses a range of comfortable, in-office tests to understand exactly what is happening with your tear production, tear film quality, and drainage system.
Your eye doctor will carefully examine your eyelids, the openings of your tear drainage system, and the surface of your eye using a microscope called a slit lamp. This allows us to identify eyelid malposition, signs of inflammation, blocked oil glands, or surface damage caused by dryness.
We also evaluate how well your eyelids close and how completely you blink, since incomplete blinking is a common and often overlooked contributor to dry eye.
The meibomian glands are small oil-producing glands located along your eyelid margins. They produce the oily outer layer of your tear film, which prevents tears from evaporating too quickly. When these glands become blocked or dysfunctional, a condition called meibomian gland dysfunction, your tear film breaks down faster than it should.
We evaluate the health of these glands as a routine part of dry eye assessment, since meibomian gland dysfunction is one of the most common underlying causes of chronic dry eye.
Several standardized tests help us measure how many tears you produce and how stable your tear film is. The Schirmer test uses a small paper strip placed beneath your lower eyelid to measure tear volume over a few minutes. Other tests use special dyes to reveal dry spots, damaged areas on the cornea (the clear front surface of the eye), or early signs of tear film instability.
To assess whether your tear ducts are blocked or draining slowly, your eye doctor may apply a small amount of colored dye to your eye and observe how quickly it clears. We may also gently flush saline through the drainage system to locate any blockage. In more complex cases, imaging studies can be used to pinpoint the exact location of an obstruction.
Non-Surgical Dry Eye Treatments
Most patients with dry eye and tearing related to dry eye can find meaningful relief through non-surgical approaches. Our team builds individualized treatment plans that address the specific causes driving your symptoms, rather than offering a one-size-fits-all solution.
Over-the-counter lubricating drops are often the first step in dry eye management. Preservative-free formulas are recommended for patients who need frequent applications or who have sensitive eyes, since preservatives can cause irritation with repeated use.
Thicker gels and ointments last longer but may temporarily blur your vision, making them better suited for nighttime use. Your eye doctor can guide you toward the right formulation for your specific tear profile.
When over-the-counter drops are not providing enough relief, prescription medications can reduce the inflammation that damages the eye surface and improve the quality of the tears your eyes produce. Some medications target increased tear production directly, while others address the inflammatory cycle that keeps dry eye chronic and progressive.
Punctal plugs are tiny, biocompatible devices inserted into the small drainage openings of your eyelids to slow tear drainage and keep moisture on your eye surface longer. They are available in temporary and longer-lasting options.
Most patients do not feel the plugs once they are placed. For patients whose dryness is contributing to reflex tearing, conserving natural tears with punctal plugs can reduce overflow as well as dryness.
Consistent eyelid hygiene is a cornerstone of treatment for meibomian gland dysfunction. Daily gentle cleansing removes bacteria, excess oils, and debris that can clog gland openings and disrupt the tear film. Warm compresses applied to closed eyelids help soften thickened oils in the glands so they flow more freely and contribute properly to your tear film.
Many patients are surprised by how much improvement comes from a consistent daily routine of warm compresses and eyelid cleaning, especially when combined with other treatments.
For patients with significant dry eye, including those with conditions like keratoconus, post-LASIK dryness, or severely irregular corneal surfaces, specialty contact lenses can provide both vision improvement and symptom relief. Scleral lenses are large-diameter lenses that vault over the cornea and rest on the white of the eye, holding a reservoir of moisture against the eye surface throughout the day.
Our optometry team includes Dr. Paul Zerbinopoulos, O.D., who specializes in scleral and moisture-retention lens fitting, and Dr. Earle Scharff, O.D., who brings more than 40 years of experience fitting specialty lenses and managing complex ocular surface conditions. Dr. Whitney Catanio, O.D., also provides comprehensive dry eye management for a wide range of patients, including children with pediatric dry eye.
Surgical Options for Epiphora
When tear duct blockages or eyelid problems are causing persistent epiphora and non-surgical approaches have not resolved the issue, surgery can often restore normal drainage and significantly improve quality of life. Our team coordinates care closely so that your ocular surface health is optimized before and after any surgical procedure.
DCR (pronounced dak-ree-oh-sis-toe-rye-NOS-toe-mee) is the most commonly performed surgery for a blocked tear duct. It creates a new drainage pathway that connects the tear sac directly to the inside of the nose, bypassing the blocked area entirely.
The procedure can be performed through a small incision near the side of the nose, or entirely through the nose using a small camera called an endoscope, which avoids any external incision. Success rates are high when performed by experienced surgeons, and most patients notice a dramatic reduction in tearing.
For simpler or more recent blockages, a thin probe can be passed through the tear drainage system and flushed with saline to clear the obstruction. This is often performed in the office under local anesthesia with minimal downtime.
Probing is most effective for blockages caused by mucus plugs or early narrowing rather than permanent scarring. Your eye doctor will determine whether this approach is appropriate based on your examination findings.
When a malpositioned eyelid, such as an eyelid turned inward or outward, is causing or contributing to epiphora, surgical correction of the eyelid position can restore proper tear drainage and protect the eye surface. These procedures also improve how the eyelid spreads tears across the eye, which can relieve dryness as well as overflow tearing.
Our oculoplastic surgeon collaborates directly with our cornea and dry eye specialists when eyelid structure is a contributing factor, ensuring that all aspects of your tear system are addressed together.
Preparing for Surgery and Managing Dry Eye Afterward
A healthy eye surface before surgery leads to better outcomes and a smoother recovery. Our team takes a proactive approach to evaluating and treating dry eye as part of preparation for any ocular procedure, including cataract and refractive surgery.
Dry eye can affect the accuracy of pre-surgical measurements and slow healing after procedures like cataract surgery or LASIK. Our corneal specialist, Dr. Christopher Newton, M.D., and our dry eye team work together to evaluate and stabilize the ocular surface before surgery, reducing the risk of complications and supporting the best possible visual outcome.
This may involve a course of lubricating drops, prescription anti-inflammatory medications, eyelid hygiene therapy, or specialty lenses before your surgical date.
Some patients experience temporary dry eye symptoms after tear duct or eyelid surgery as the tissues heal and the tear system adjusts. Using preservative-free artificial tears regularly helps maintain comfort and supports healing.
Your eye doctor will provide specific post-operative instructions, which typically include keeping the area clean, avoiding heavy lifting or straining, and protecting your eyes from dust and wind. Anti-inflammatory drops or antibiotic drops may also be prescribed depending on your procedure.
Follow-up appointments after surgery are an important part of ensuring lasting results. We monitor healing, confirm that drainage is functioning properly, and address any ongoing dry eye symptoms with appropriate maintenance therapy. Some patients benefit from continuing dry eye treatment even after a successful surgical procedure.
Frequently Asked Questions
Here are answers to questions our patients commonly ask about epiphora, dry eye, and their treatment, with guidance to help you make informed decisions about your care.
For some patients, dry eye has a specific, treatable cause such as a medication side effect or meibomian gland blockage that can be resolved with targeted treatment. For others, especially those with underlying systemic conditions or age-related changes, dry eye is a chronic condition that is managed rather than cured. The goal of treatment is to reduce symptoms, protect the eye surface, and maintain quality of life over the long term. Regular follow-up allows your eye doctor to adjust your treatment plan as your needs change.
Both conditions can cause overflow tearing, and they can also occur at the same time. The key difference is that tearing from a blocked duct tends to be persistent and not relieved by lubricating drops, while tearing from dry eye often comes with burning, grittiness, or fluctuating vision. Only a clinical examination, which may include drainage testing and tear quality assessment, can accurately identify the cause. Attempting to self-diagnose based on symptoms alone can lead to treatment that does not address the actual problem.
Scleral lenses can be an excellent option for patients who have significant dry eye alongside conditions like keratoconus, irregular astigmatism, or post-surgical corneal changes. Because they hold a layer of fluid against the eye surface, they provide continuous moisture and can also improve vision in ways that standard soft lenses cannot. Whether they are right for you depends on the specific nature of your cornea, tear function, and vision needs. Our specialty lens team can perform a comprehensive evaluation to determine whether scleral lenses are appropriate for your situation.
Dry eye does not automatically disqualify you from surgery, but it does need to be evaluated and, in many cases, treated before the procedure. Uncontrolled dry eye can affect pre-surgical measurements and increase the likelihood of discomfort and slower healing afterward. Our team routinely screens for ocular surface disease before any surgical consultation, and we will work with you to prepare your eyes before scheduling a procedure. In some cases, a period of focused dry eye treatment before surgery leads to significantly better outcomes.
A sudden or significant worsening of dry eye symptoms warrants prompt attention from an eye doctor. This kind of change can signal a new underlying condition, a reaction to a medication, or a developing problem with the eye surface that needs evaluation before it causes damage. If you also experience sudden changes in vision, significant eye pain, or discharge, treat this as an urgent matter and contact our office as soon as possible. Dry eye that becomes severe and goes untreated can lead to corneal damage over time.
Yes, both conditions can affect children, although they are more commonly seen in adults. In young children, a narrowed or partially blocked tear duct is a frequent cause of persistent tearing and is often managed with massage techniques, antibiotic drops, or probing if necessary. Pediatric dry eye is less common but does occur, particularly in children with certain systemic conditions or allergies. Dr. John Donahue, M.D., PhD, our pediatric ophthalmologist, along with our optometry team, provides evaluation and management for children with tearing and dry eye concerns.
Schedule a Visit at Rhode Island Eye Institute
If you are living with persistent watery eyes, chronic dryness, or both, our team is here to help you find answers and real relief. Rhode Island Eye Institute brings together fellowship-trained corneal specialists, experienced dry eye clinicians, and specialty lens experts, all working together under one roof to provide care that is tailored to your specific needs. We invite you to schedule an appointment and take the first step toward greater comfort and healthier eyes.