# Watery eye (epiphora) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FS03.00 - condition scope only, no dose · Nasolacrimal Duct Obstruction - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK532873/ · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Watery eye (epiphora) - disease-level clinical article (watery-eye-full.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text WATERY EYE (EPIPHORA) Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FS03.00 - condition scope only, no dose · Nasolacrimal Duct Obstruction - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK532873/ · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Watery eye (epiphora) - disease-level clinical article (watery-eye- full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (11) - Sudden-onset tearing usually points to a local cause [eye discharge] - Gradually worsening tearing suggests narrowing of the nasolacrimal duct [eye discharge · stricture] - Watering plus discomfort right after waking can point to a recurring corneal erosion - A painful, one-sided watery eye raises concern for a foreign body, corneal ulcer or abrasion, keratitis, glaucoma, or iritis [foreign body] - Itching suggests an allergy, sometimes triggered by eye drops such as glaucoma medication [itching] - Burning and discomfort on blinking that is worse in the morning suggests dry eye [dry eye] - Purulent discharge points to bacterial infection, while bloody discharge raises concern for a lacrimal sac tumor [eye discharge · pus] - Tearing that occurs with eating, chewing, or talking suggests aberrant regeneration of the facial nerve (crocodile tears) [eye discharge] - Certain eye drops, including pilocarpine, phospholine iodide, and idoxuridine, can cause tear- duct obstruction - Prior radiation to the eye area for skin cancer can scar the punctum or canaliculus [scarring] - The overflow itself causes blurred vision, and discharge when the lacrimal sac is infected or a foreign body sits in the canaliculus [blurred vision · eye discharge · foreign body] SIGNS - what you find (11) - Brow droop, upper-lid retraction, or eye closure when chewing points to old facial nerve palsy with aberrant regeneration [cranial nerve palsy] - A mass above the medial canthal tendon suggests an ethmoid lesion, while one below it suggests a lacrimal sac problem - Redness and tenderness over the lacrimal sac points to dacryocystitis [redness] - Mucoid discharge expressed from the puncta on pressing the lacrimal sac indicates a mucocele [eye discharge] - A firm, non-fluctuant mass over the sac raises concern for a lacrimal sac tumor - A lower lid that fails to snap back promptly after traction points to orbicularis weakness or lax canthal tendons - Fluorescein staining high on the cornea suggests a foreign body lodged under the upper eyelid [foreign body] - Punctate corneal staining can be seen with trichiasis - An upper lid that everts easily with upward pressure and shows a follicular reaction suggests floppy eyelid syndrome - The globe moving with the lower lid on downward traction, or conjunctival bands, indicates symblepharon - Constant wiping excoriates the eyelid skin and leaves the lower lids lax TESTS (9) - A dacryocystogram confirms true patency of the tear drainage system when the diagnosis is unclear - If irrigation shows patency but tearing continues, dacryocystography can still reveal an underlying narrowing - Fluid backing up through the same canaliculus being irrigated points to a canalicular obstruction - Fluid backing up through the opposite canaliculus points to a nasolacrimal duct obstruction - Probing the canaliculus with a Bowman probe localizes the level of a canalicular blockage - Schirmer testing measures reflex tearing, but many dry-eye patients still test normal on it - One referral practice found dry eye responsible for about 40 percent of its epiphora cases - Meibomian gland dysfunction with tear-film instability was the main cause of tearing in up to 20 percent of chronic epiphora patients - Botulinum toxin injected into the lacrimal gland relieves crocodile tears for three to four months IF NOT THIS - what else fits (7) - Punctal problems such as stenosis, membrane, ectropion, or plugging account for roughly 35 percent of adult epiphora - Canalicular disease, such as stenosis, infection, or scarring, accounts for roughly 15 percent of cases - Nasolacrimal duct obstruction, mostly primary acquired, accounts for roughly 24 percent of cases - Weakness of the tear pump, from eyelid laxity, facial nerve palsy, or floppy eyelid syndrome, accounts for roughly 11 percent - Pseudoepiphora, reflex tearing from dry eye or ocular inflammation rather than a drainage problem, accounts for roughly 11 percent - Nasal and sinus disease accounts for roughly 4 percent of cases - Aberrant nerve regeneration after facial palsy accounts for roughly 2 percent of cases Source StatPearls "Epiphora" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Overflow of tears from poor drainage (nasolacrimal duct blockage, eyelid malposition) or from reflex overproduction (irritation, allergy, infection). Since the right response depends on the cause, there is no single drug to point to here; a GP's role is examining for a treatable cause and referring (for example for duct probing or lid surgery) when indicated. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Overflow of tears from poor drainage (nasolacrimal duct blockage, eyelid malposition) or from reflex overproduction (irritation, allergy, infection). Since the right response depends on the cause, there is no single drug to point to here; a GP's role is examining for a treatable cause and referring (for example for duct probing or lid surgery) when indicated. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - A firm, hard, non-fluctuant medial canthal mass or bloody tear discharge indicates a possible lacrimal sac tumor requiring urgent specialist evaluation. RED FLAG - Erythema, swelling, and tenderness over the lacrimal sac indicate acute dacryocystitis requiring prompt treatment and evaluation. A watery eye accompanied by pain, redness, or vision change suggests infection or another eye disease rather than simple duct blockage, and in an infant a persistently watery, mucky eye since birth suggests congenital duct obstruction. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)