Treatment Options For Excessive Tearing (Including Surgery)

Treatment Options For Excessive Tearing (Including Surgery)

Do your eyes tear up all the time, to the point where it’s annoying or even embarrassing? Excessive tearing in the medical world is known as epiphora. Chronic tearing can cause a social problem where you need to constantly have tissues on hand because tears are always running down your face. In this article, I’ll review the main causes of excessive tearing as well as review surgical and nonsurgical treatment options.

Main causes of excessive tearing

Outside of emotional tearing (i.e. crying), these are the 3 main causes of excessive tearing:

  1. A blockage in your tear duct (the main drain of the eye). If you think of your eye like a sink, when there’s a blockage in the drain of your eye tears will overflow onto your cheek.
  2. Droopy or floppy lower eyelids, also known as ectropion. If your lower eyelids are loose, tears aren’t able to get to your tear duct and can pool in your eye.
  3. Advanced dry eye disease. If your eyes are dry, it sends a message to your brain to make more tears to moisten and lubricate your eyes.

Evaluating excessive tearing

If you have excessive tearing, your doctor will examine your eyes to look for signs of dryness. They will also check your lower eyelids to see if they’re loose. They will also most likely use a test called probing and irrigation to determine if there is a blockage in your tear duct. This test involves squirting water into your tear duct to see if you taste it in the back of your nose. If you do not taste fluid, there is likely a blockage of your tear duct.  

Some tear duct obstructions are complete, which means the duct is 100% blocked, whereas others are partial, which means the duct is less than 100% blocked. If your tear duct is mostly or completely blocked, the treatment of choice is a surgery called a dacryocystorhinostomy or DCR for short.

RELATED: Here’s Why Your Eyes Water All the Time

DCR surgery for excessive tearing

DCR usually takes place in the surgery center under either general anesthesia or sedation. 

First, an incision is made either between the eye and the nose or from inside the nose itself. Then, a small hole is made in the bone to create a detour for the tears to drain through. A tube is then placed through the new opening to stent the system open. The tube usually stays in for about 3 months after surgery and does not usually cause any discomfort.

The surgery can be painful afterward and is usually controlled with pain medicine. If you have DCR surgery, you’re typically out of commission for about 3 days and then can return to normal life (except no exercise for one week).

Risks of the surgery include bleeding and infection anytime surgery is done on the body. However, the surgery itself has a success rate of about 95%.

Balloon dacryoplasty for excessive tearing

If the tear duct is less than 50% blocked, a procedure called a balloon dacryoplasty can be used to widen your tear duct. I like to think of this procedure as angioplasty for the tear duct.

This procedure is usually performed under sedation and as a same-day procedure at a surgery center.

A balloon is inserted into the tear duct at 3 different levels and is then inflated to make the tear duct wider. Just like with the DCR surgery, a tube is inserted as a stent for about 3 months. The success rate is lower than with a formal DCR surgery, which is why it’s used for smaller obstructions.

RELATED: Eyelid Ectropion and Entropion: Causes, Symptoms, and Surgical Repair

Other treatment options for tearing

For very mild tear duct obstructions, a short course of steroid eye drops can sometimes be enough to treat the tearing. If your doctor determines your tearing is due to a loose lower eyelid, eyelid tightening procedures can be used to help control your symptoms.

If your tearing is due to dry eye syndrome, artificial tears and ointments can be used to lubricate your eye and prevent your brain from thinking it needs to make more tears.

RELATED: Best Artificial Tears For Dry Eyes

Final thoughts

The bottom line is that you don’t have to live with excessive tearing! Set up an appointment with your friendly eye doctor today to take the next step toward a tear-free life.

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Paul Johnson, MD
Dr. Paul Johnson is a board-certified ophthalmologist with subspecialty training in cosmetic and reconstructive oculoplastic surgery. He performs facial rejuvenation procedures including upper and lower eyelid blepharoplasty (eyelid lift/contouring), brow lifts, Botox injections, soft tissue fillers (Radiesse/Juvederm/Restylane), and chemical peels with meticulous attention to detail. Dr. Johnson is also skilled in reconstructive oculoplastics including ptosis repair, excision, and reconstruction of eyelid skin cancer, orbital decompression surgery, repair of orbital fractures, eye socket reconstruction, management of facial nerve paralysis (Bell’s palsy), blocked tear duct repair (dacryocystorhinostomy), ectropion and entropion repair, management of thyroid eye disease, enucleation and evisceration surgery, and the repair of orbital, eyelid, and tear duct trauma. He attended Johns Hopkins University and Jefferson Medical College. He completed his ophthalmology residency at the prestigious New York Eye & Ear Infirmary, and his oculoplastics fellowship at the top-rated Wills Eye Institute. He has authored multiple publications and has been actively involved in teaching future ophthalmologists at both New York Eye & Ear and Wills Eye Institute.

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