A persistently watering eye — known medically as epiphora — is one of the most common oculoplastic referrals seen in adult eye clinics. It is almost always caused by either a blockage in the tear drainage system or by something irritating the eye and triggering over-production of tears. Both are diagnosable and treatable.
Why does my eye keep watering?
A persistently watering eye — the medical term is epiphora — is one of the most common oculoplastic complaints seen in adult eye clinics. Patients often describe it as an eye that 'constantly runs', makes them look as though they are crying, and causes blurred vision in public or when driving.
The tear film is produced continuously by the lacrimal gland and must drain away through a small drainage system at the inner corner of each eye. This system runs from two tiny openings (puncta) on the upper and lower eyelid margins, through fine tubes (canaliculi), into a sac (lacrimal sac), and finally down a bony channel (nasolacrimal duct) into the nose. If any part of this pathway narrows or blocks, tears overflow down the cheek.
The other main cause is not blockage but paradoxical over-production — the eye waters because something is irritating it (a turned-in eyelid, dry eye, or allergy) and the lacrimal gland responds by producing more tears than the drainage system can handle. Identifying which mechanism is responsible is critical to choosing the right treatment.
Common causes of adult watering eye
Nasolacrimal duct obstruction (NLDO) is the most common cause in adults over 40, occurring more often in women. The nasolacrimal duct gradually narrows with age, chronic low-grade inflammation, or previous sinus disease, until tears can no longer drain effectively. The blockage is usually at the junction of the lacrimal sac and the nasolacrimal duct.
Canalicular stenosis is narrowing or blockage of the fine tubes (canaliculi) between the puncta and the lacrimal sac. Common causes include previous viral conjunctivitis (particularly herpes simplex), certain chemotherapy agents (notably docetaxel), chronic use of eye drops containing preservatives, or trauma.
Punctal stenosis is narrowing of the punctal openings themselves. Often age-related, it can also follow chronic blepharitis, topical medication use, or trauma. Punctal plugs used for dry eye can also partially block the punctum.
Eyelid malposition causing tears to miss the punctum: an ectropion (outward-turning lower eyelid) is a very common cause of watering eye in older patients. The lower lid sags away from the eye, the punctum no longer contacts the tear lake, and tears simply spill over.
Other causes include: entropion (inward-turning lid) causing reflex tearing from lash irritation; blepharitis and meibomian gland dysfunction triggering reflex hypersecretion; dacryocystitis (infection of the lacrimal sac); and, rarely, lacrimal sac tumours.
How is epiphora assessed?
Mr Mohyudin's oculoplastic assessment of a watering eye includes a full slit-lamp examination to look for eyelid malposition, punctal anomalies, corneal irritation, and signs of blepharitis. The puncta are examined and probed gently to assess patency. A syringe and cannula are passed through the punctum to irrigate the lacrimal system with saline — this determines where any obstruction lies and whether the system is patent, narrowed, or completely blocked.
If obstruction is confirmed and surgery is being considered, a dacryocystogram (DCG) or dacryoscintigraphy (nuclear lacrimal scan) may be arranged to map the anatomy of the blockage. CT dacryocystography is occasionally needed if a mass or unusual anatomy is suspected.
The pattern of watering also gives diagnostic clues. Watering predominantly with cold or wind suggests reduced lower eyelid tone or dry eye reflex rather than mechanical obstruction. Watering accompanied by sticky discharge and a swelling at the inner corner of the eye points to dacryocystitis or mucocoele.
Non-surgical treatments for watering eye
Not every watering eye requires surgery. The treatment depends entirely on the underlying cause.
Punctal stenosis can sometimes be managed with punctal dilation in clinic using a fine dilator passed through the opening under topical anaesthesia. If the punctum has completely stenosed over, a minor procedure to open it (punctoplasty) can be performed under local anaesthetic.
Ectropion causing overflow tearing is treated with ectropion repair surgery — tightening the lower lid so the punctum returns to contact with the eye. This is frequently all that is needed, and the watering resolves completely.
Blepharitis-related reflex watering is treated with lid hygiene, warm compresses, and tear lubricants. Improving the tear film quality reduces the stimulus for over-production.
Canalicular stenosis may be managed with intubation — passing a fine silicone tube through the canaliculi to maintain patency — though results are variable depending on the severity and location of stenosis.
Complete nasolacrimal duct obstruction in adults does not resolve spontaneously and does not respond to massage or drops. The definitive treatment is dacryocystorhinostomy (DCR) surgery.
What is DCR surgery (dacryocystorhinostomy)?
Dacryocystorhinostomy — usually abbreviated to DCR — is the operation that corrects nasolacrimal duct obstruction by creating a new drainage passage from the lacrimal sac directly into the nasal cavity, bypassing the blocked duct entirely.
External DCR is the traditional approach and remains the gold standard with the highest long-term success rates (around 90–95%). A small incision is made in the skin beside the nose, the lacrimal sac is identified and opened, and a window is made through the thin nasal bone into the nasal cavity. The sac is sutured to the nasal mucosa to create a permanent new opening. A fine silicone tube (stent) is passed through the new passage and left in place for two to three months to maintain patency while healing occurs.
Endoscopic (endonasal) DCR is performed without a skin incision, working entirely through the nasal cavity using a nasal endoscope. The approach is less invasive but success rates are slightly lower (around 85–90%), and it requires suitable nasal anatomy. It is particularly appropriate for patients who are very concerned about a visible scar, or for those with canalicular blockage.
Both procedures are performed under general anaesthetic as a day case, typically taking around 45–60 minutes. Most patients go home the same day.
DCR recovery and what to expect
Immediately after surgery you will have a light dressing at the wound site. The inside of the nose may feel blocked for a day or two due to swelling. There is usually some bloodstained nasal discharge and some bruising around the inner corner of the eye and nose — this typically resolves within 10–14 days.
You will be prescribed a course of antibiotic and steroid eye drops to prevent infection and reduce scarring. Nasal saline rinses are recommended from day two to keep the nasal passage clear. You should avoid blowing your nose forcefully for at least two weeks to prevent disrupting the new anastomosis.
The silicone stent is removed at a clinic appointment at approximately 6–8 weeks after surgery. This is a quick, painless procedure done under topical anaesthesia.
Improvement in watering is usually noticeable within a few weeks, though the full result is best assessed at three months. If the watering does not resolve completely, a second procedure can be considered, though this is needed in fewer than 10–15% of cases.
Most patients return to desk work within 3–5 days. Heavy lifting, swimming, and contact sport should be avoided for two weeks.
DCR surgery at Spire Elland Hospital with Mr Mohyudin
Mr Mohamed Mohyudin is a fellowship-trained oculoplastic surgeon with specific training in lacrimal surgery. He performs DCR surgery at Spire Elland Hospital in Elland, West Yorkshire, conveniently located near Halifax, Huddersfield, and Bradford.
Private DCR surgery with Mr Mohyudin is available as a self-pay package (all-inclusive) or through major health insurance. A consultation is always required first so that the lacrimal system can be properly assessed, the correct procedure planned, and pre-operative photographs and measurements taken.
To arrange a consultation, call Spire Elland Hospital on 01422 324000 or email mnmohyudin@doctors.org.uk. Patients do not need a GP referral to be seen privately, though a referral letter is helpful.
Mr Mohyudin also performs related lacrimal procedures including punctoplasty, silicone intubation, and canalicular repair, and sees children with blocked tear ducts who may need lacrimal probing.
Frequently Asked Questions
Is a watering eye always caused by a blocked tear duct?
No. While nasolacrimal duct obstruction is a common cause, watering eyes can also result from a turned-out lower eyelid (ectropion), dry eye triggering reflex over-production, blepharitis, corneal irritation, or allergy. A thorough oculoplastic assessment is needed to identify the correct cause before any treatment is offered.
How much does DCR surgery cost privately in the UK?
Self-pay DCR surgery in the UK typically ranges from approximately £2,000 to £3,500 depending on the hospital, surgeon, and whether the procedure is performed externally or endoscopically. The package usually includes the surgeon's fee, anaesthetist, hospital facility, and follow-up appointments including stent removal. Always confirm what is included in writing.
Will I have a visible scar after DCR surgery?
External DCR leaves a small scar at the side of the nose, approximately 1–1.5 cm long. In most patients this fades to a barely visible fine line within six months. Endoscopic DCR involves no external incision and no skin scar. The choice of approach depends on anatomy and clinical preference, and Mr Mohyudin will discuss the options at consultation.
Can watering eyes be treated with eye drops?
Eye drops cannot open a mechanically blocked nasolacrimal duct. However, if the watering is caused by dry eye disease, blepharitis, or allergy, appropriate drops (lubricants, antibiotic/steroid combinations, antihistamines) can significantly reduce tearing. The correct diagnosis determines whether drops are likely to help.
How long is the waiting time for NHS DCR surgery?
NHS waiting times for elective DCR surgery vary considerably by region but are commonly 12–18 months or longer following the post-pandemic backlog. For patients whose watering is causing significant quality of life impact or work difficulties, private treatment with Mr Mohyudin can typically be arranged within a few weeks of referral.
Is DCR surgery performed under local or general anaesthetic?
At Spire Elland Hospital DCR is performed under general anaesthetic as a day case. This is standard practice for most patients. The procedure takes approximately 45–60 minutes and patients usually go home the same afternoon.
Mr Mohamed Mohyudin
MBChB BSc MSc FRCOphth CCT — Consultant Ophthalmic Surgeon, Spire Elland Hospital, Yorkshire. GMC 7039600.
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