Watery eyes (epiphora): causes, treatment and when to see a doctor

The NHS says it is normal for your eyes to water in smoky environments or if you are outside in the cold or wind. An eye injury or something in your eye, such as an eyelash or a piece of grit, can also make them water. Other causes it lists are blocked tear ducts, an allergy or infection, an eyelid drooping away from the eye (ectropion) or other eyelid problems, dry eyes, Bell's palsy, and some medicines and cancer treatments.

Moorfields describes what happens with blockages and eyelid problems. If the lower eyelid turns outwards, tears do not drain properly. If your eyelid turns in or an eyelash grows inwards, it irritates the eye. A hospital trust leaflet says that if any part of the drainage pathway is blocked, the eye will water, and that this may happen in children or in the elderly.

The NHS says treatment may not be needed if your watery eyes are not causing problems. If treatment is needed, it will depend on the cause. Eye drops, gels, ointments or sprays can help if your eyes are dry. Antibiotic eye drops can help if you have an eye infection, and medicines can help if you have an allergy. Anything in your eye, like a piece of grit, can be removed. A small operation may be needed if you have a problem with your eyelids or blocked tear ducts.

A pharmacist can help, according to the NHS: you can ask what you can do to treat it yourself, such as cleaning and protecting your eyes, what you can buy, such as cleaning solutions, eye drops or allergy medicines, and whether you need to see an optician or GP. If the GP cannot find the cause, they may refer you to an eye specialist (ophthalmologist) for tests.

For an outward-turning lower lid, Moorfields says the most common procedure involves tightening the tendon that holds the outer eyelid in place. For blocked tear ducts, the main option is a DCR operation, described below.

Everyone makes tears all the time to keep the eye moist, healthy and comfortable. With each blink the tears are drained away through two tiny holes in the upper and lower eyelids, along very small tubes, into the tear sac beside the nose, and then down the nasolacrimal duct into the nose, finally draining to the back of the throat. A hospital trust leaflet explains that if any part of that pathway is blocked, the eye will water.

Epiphora is the medical word for tears running over the eyelid onto the cheek. It is different from simply producing a lot of tears when you cry or when the wind is cold. The aim of assessment is to work out whether the problem is a drainage blockage, a surface irritation, or the position of the eyelids.

The NHS says babies sometimes have watering eyes because their tear ducts have not fully developed, and it usually gets better by the time they are a few weeks old. Moorfields says that in babies watering often resolves within a few weeks without treatment.

If a sticky liquid forms around the eyes it can be removed with a piece of cotton wool soaked in sterile water, which means water that has been boiled and then cooled. Moorfields adds that massaging the tear ducts, by applying light pressure with a finger and thumb to the outside of the nose, may help dislodge tears collected in the upper part of the duct and encourage the duct to develop.

The Gloucestershire leaflet describes two simple tests. In syringing, salt water is flushed through the tear duct. Normally this fluid passes into the throat and is swallowed, but if there is a blockage the water has nowhere to go and spills out onto the cheek. In probing, a very fine probe can usually be passed through the tear duct into the tear sac, and if this cannot be done there is most likely a blockage.

The NHS says that if a GP cannot find what is causing your eyes to water, they may refer you to an eye specialist (ophthalmologist) for tests.

Dacryocystorhinostomy (DCR) is a common surgical procedure for blocked tear ducts. It creates a new channel from the tear sac to the inside of the nose, so tears can bypass the blocked part of the duct. The Gloucestershire Hospitals leaflet says the only effective treatment of any blockage is an operation.

It is usually carried out under general anaesthetic, with a small cut at the side of the nose over the tear sac, or occasionally inside the nose with no skin wound. A new path is made through bone from the tear sac into the nose, and silicone tubing is left in place for at least 6 weeks to make sure scar tissue does not close it. The tube is removed at an outpatient appointment from 6 weeks to months later, depending on where the blockage was or on previous surgery. With the tube in place your eye may continue to water, but if the operation has been successful this will stop when the tube is removed.

The leaflet lists the main complications. There will be a small scar on the side of the nose that normally fades within 6 months. There may be bleeding from the nose, and if it becomes heavy or lasts longer than 20 minutes you should contact a local minor injury unit or emergency department. And 1 in 10 of these operations does not solve the problem, in which case it may need to be repeated.

The NHS says to see a GP if your eyes keep watering and it is stopping you doing everyday activities, your eyelid is turning inwards or drooping away from your eye, or you have any lumps or swellings around your eyes that have not got better with treatment from a pharmacist.

Ask for an urgent GP appointment or get help from NHS 111 if you have any changes to your vision, such as loss of vision, or severe eye pain.

The hospital trust leaflet describes a painless swelling near the nose (a mucocele) that can become infected and painful. A swelling like that should be assessed rather than left.

Start with a pharmacist, an optometrist or your GP, who can look for obvious causes such as conjunctivitis, dry eyes or eyelid malposition and refer to an NHS ophthalmology service if drainage is suspected. DCR is performed by specialist eye surgeons, sometimes with ear, nose and throat input.

Private eye hospitals and consultants also provide assessment and surgery. If you consider a private route, ask for an itemised quote that covers the consultation, tests, surgery, tube removal and follow-up, and ask for the findings to be shared with your GP.