Why are my eyes always watering? A guide to blocked tear ducts and lacrimal disorders

Why Are My Eyes Always Watering? A Guide to Blocked Tear Ducts and Lacrimal Disorders

Persistently watery eyes are a common and often frustrating complaint, particularly in Dubai, where environmental factors such as heat, dust, air conditioning, and wind can exacerbate any underlying tendency toward excessive tearing. Many patients assume their watery eyes are simply a symptom of allergies or dry eye and are surprised to learn that the actual cause may be a blockage or abnormality in the tear drainage system.

How does the tear drainage system work?

The eyes produce tears continuously to keep the surface of the eye lubricated. These tears drain through small openings at the inner corners of the eyelids (called puncta), travel through narrow channels (canaliculi), collect in a sac (the lacrimal sac), and drain down into the nose through the nasolacrimal duct. This is why your nose runs when you cry.

When any part of this drainage pathway is narrowed, blocked, or damaged, tears cannot drain at their normal rate and overflow onto the cheek, a condition called epiphora.

What causes blocked tear ducts?

The most common cause in adults is age-related narrowing or scarring of the nasolacrimal duct. Other causes include chronic infection or inflammation, trauma to the nasal bones or lacrimal area, previous nasal or sinus surgery, certain medications (including some chemotherapy agents), and, less commonly, a tumour in the lacrimal drainage pathway.

In infants and young children, blocked tear ducts are extremely common and are usually caused by a thin membrane at the lower end of the duct that has not yet opened fully. Most cases in infants resolve spontaneously within the first year of life.

Is it always a blocked duct?

Not always. Watery eyes can also be caused by eyelid malposition, where the puncta (drainage openings) are not in the correct position to collect tears efficiently, or by dry eye disease, which paradoxically causes reflex tearing as the eye tries to compensate for inadequate baseline lubrication. Identifying the correct cause requires a clinical examination.

What are the symptoms?

The most obvious symptom is constant or frequent overflow of tears onto the cheek, which can be particularly pronounced in wind, cold, or bright light. Patients often describe needing to constantly dab their eyes. If there is also infection of the lacrimal sac (dacryocystitis), there may be swelling, redness, and discharge at the inner corner of the eye, and in acute cases significant pain and fever.

How is it diagnosed?

An oculoplastic specialist will examine the eyelids and puncta, assess the position of the lids, and may perform irrigation of the tear ducts, passing a small volume of saline through the drainage system to assess its patency. Imaging, including a dacryocystogram or CT scan, may be used in more complex cases.

What are the treatment options?

Treatment depends on the cause and location of the obstruction. Mild narrowing may be treated with dilation and probing of the duct. Complete obstruction typically requires surgery, the most common procedure is dacryocystorhinostomy (DCR), which creates a new drainage pathway from the lacrimal sac directly into the nasal cavity, bypassing the blocked portion of the duct. DCR can be performed via an external incision or endoscopically through the nose.

For punctal stenosis (narrowing of the drainage opening at the eyelid), a minor punctoplasty procedure to widen the opening is often effective. For dry eye-related reflex tearing, treatment focuses on managing the underlying dry eye condition.

Is DCR surgery serious?

DCR is a well-established surgical procedure with high success rates, typically greater than 85 to 90 percent for primary cases. It is performed under local or general anesthesia as a day procedure. Recovery involves some swelling around the nose and eye area and mild nasal bleeding in the first few days, but most patients return to normal activities within one to two weeks.

About Dr. Lama Jurdy

Dr. Lama Jurdy is a Specialist Ophthalmologist and Oculoplastic Surgeon at Magrabi Health, Dubai, with specialist training in lacrimal surgery including DCR. She consults in Arabic and English. To book a consultation, visit drlamajurdy.com.