Epiphora is the medical term for persistent, excessive eye watering, a common complaint among older adults. The condition occurs when the delicate balance between tear production and drainage is disrupted. This imbalance results in an overflow, causing tears to spill onto the cheek, blurring vision and requiring constant wiping. Causes generally fall into two categories: the eye producing too many tears or the eye failing to drain them efficiently.
The Paradox: Watering Caused by Dryness
One of the most frequent causes of epiphora in older people is dry eye syndrome. As a person ages, the quality and stability of the tear film deteriorate, often compounded by changes in the meibomian glands that produce the tear film’s oily layer. This leads to increased tear evaporation, creating a dry and irritated ocular surface.
The tears that constantly lubricate the eye are called basal tears, distinct from the reflex tears produced in response to irritation. When the eye’s surface becomes overly dry, it triggers a reflex arc to protect the eye. This signal prompts the lacrimal gland to generate a massive flush of watery, reflex tears.
These reflex tears are produced in such volume that they quickly overwhelm the eye’s normal drainage capacity. The eye is essentially watering because it is too dry, creating a paradoxical situation where the solution becomes the problem of overflow. This reflex tearing is often worse in environments with wind, smoke, or low humidity, which further destabilize the tear film.
Mechanical Failures in the Tear Drainage System
Beyond overproduction, the second major cause of epiphora is a failure in the eye’s physical drainage system, which acts like a plumbing network. Tears drain through two tiny openings, called puncta, located in the inner corner of the upper and lower eyelids. From the puncta, tears travel through small tubes (canaliculi), collect in the lacrimal sac, and finally drain into the nose through the nasolacrimal duct.
With age, this drainage pathway can narrow or become blocked, a condition known as involutional stenosis. The punctal openings themselves can narrow or close entirely (punctal stenosis), restricting the entry point for tears. Even a partial blockage prevents the system from handling the normal tear volume, causing overflow.
Age-related changes in the surrounding eyelid structures also impede drainage. The muscles and tendons that keep the eyelids taut weaken over time. This laxity can cause the lower eyelid to sag outward (ectropion). When the eyelid sags, the punctum is pulled away from the eye’s surface, making it impossible to collect tears effectively.
Conversely, the eyelid can roll inward (entropion), causing the eyelashes to rub against the eye’s surface. This irritation triggers reflex tearing, and the inward positioning moves the punctum away from its proper tear-collecting position. In both ectropion and entropion, this compromised alignment prevents tears from entering the drainage system, forcing them to run down the cheek.
Relief and Management Strategies
Addressing epiphora requires identifying whether the issue is related to overproduction or impaired drainage, as management strategies differ. For paradoxical watering caused by dry eye syndrome, the first step is often to use preservative-free artificial tears. These lubricating drops improve the stability of the basal tear film, reducing the irritation that triggers reflex tears.
Simple home measures can also stabilize the tear film, such as applying warm compresses to the eyelids for several minutes. This action helps melt thick oil secretions in the meibomian glands, improving the tear film’s oily layer and slowing evaporation. Maintaining good indoor humidity can also minimize environmental factors that exacerbate dryness.
When drainage is the main problem, an ophthalmologist may intervene to restore flow. If the puncta are narrowed, a minor procedure called punctal dilation can gently widen the opening. For deeper blockages, a surgical procedure known as dacryocystorhinostomy (DCR) can create a new drainage channel to bypass the obstruction.
If the cause is a structural eyelid problem like ectropion or entropion, a minor surgical repair can restore the proper position of the eyelid and realign the punctum. Seek professional medical advice if the watering is chronic, accompanied by pain, redness, or discharge, or if it significantly impairs vision.