Tears are essential to the performance and health of our eyes. They keep the surface of the eye moist, help with distribution of nutrients and protective cells, and wash away debris and other particles and foreign objects.
However, watery eyes, especially when accompanied by itching, redness, discharge, or puffiness around the eyelids, may indicate an allergic reaction. They could also be caused by clogged tear ducts, blepharitis (inflammation of the eyelid follicles), airborne irritants like chemicals, cigarette smoke, smog, and even aging.
Watery, itchy eyes may result in temporary blurriness, but seldom are they a medical emergency or threat to your eyesight. A health professional is usually needed only if the tearing is persistent or bothersome.
Here are the conditions that most commonly cause watery eyes, along with what to do about them.
For millions of Americans, teary eyes accompanied by itching, burning in both eyes, redness, swelling, and a thin, watery discharge are a sign of the allergy season, which can extend from early spring to late fall. Seasonal allergies, commonly known as hay fever, are triggered by the body’s reaction to allergens in the air, mostly pollens from grasses, trees, and ragweed.
The trouble begins when allergens come in contact with the eye surface and the immune system overreacts, releasing proteins known as histamines. These trigger the tearing and itching of one of the most common allergic reactions, allergic conjunctivitis.
The conjunctiva is the thin, transparent lining that covers the undersurface of the eyelids and the white coat of the eyes. It’s packed with immune system cells that release chemical substances in response to stimuli like pollens, mold, or dust mites. This chain reaction leads to inflammation of the conjunctiva, or allergic conjunctivitis.
How to manage your symptoms: The most obvious way to treat or prevent watery, itchy eyes caused by allergens is to reduce your exposure to them. When pollen counts are high, stay indoors as much as you can, close the windows, and run the air conditioner.
It may also mean keeping a pet out of the house, installing high-efficiency (HEPA) air filters in your home, removing household items that collect dust, covering mattresses and pillows with finely woven fabrics that prevent dust mites, using synthetic-fiber pillows, and installing dehumidifiers in basements and other damp rooms to prevent mold.
Medications for short-term relief—both over-the-counter and prescription—can be helpful. Sometimes, using lubricants such as artificial tears or applying cool compresses and not rubbing the eyes is sufficient to reduce the irritation from allergens. Over-the-counter eyedrops containing antihistamines—which block rather than prevent the production of histamines—are often effective. Look for products containing ophthalmic ketotifen.
If antihistamine drops fail to do the job, however, you may require prescription eyedrops. Nonsteroidal anti-inflammatory or mast cell stabilizer eyedrops may be recommended by your physician to relieve symptoms associated with allergic conjunctivitis.
Eyedrops with corticosteroids are even more potent and can have side effects, including increasing your risk of eye infection, glaucoma, and cataracts—so if you start using any of these drugs, you should schedule a follow-up appointment with your ophthalmologist.
Ironically, another cause of watery eyes can be dryness. This condition produces an irritated, burning, gritty feeling in your eye, which in turn stimulates the tear glands to overproduce as a protective response.
Dry eye is particularly common among people as they age because the tear glands tend to produce fewer or poor-quality tears. Other factors associated with dry eye span a wide range and include certain medications such as antihistamines, decongestants, anticholinergics, antidepressants, pain relievers, sleeping pills, tranquilizers, diuretics, beta-blockers, and drugs for glaucoma, benign prostatic hyperplasia, and Parkinson’s disease. Also contributing to dry eye may be certain health conditions such as Sjörgren’s syndrome, thyroid disease, skin diseases (psoriasis, eczema, and rosacea), diabetes, and shingles, as well as a diet lacking in adequate consumption of vitamin A or possibly omega-3 fatty acids.
It’s important to see your doctor for a definitive diagnosis so you can get the proper treatment. You may have dry eye if you have one or more of the following eye symptoms:
- A persistent dry, irritated, gritty feeling
- Burning or itching
- Pain or redness
- Excessive tearing for short periods
- Intermittent blurry vision
- Stringy mucous discharge
- Sensitivity to light
- Eye fatigue
- Discomfort that affects the ability to perform tasks that require sustained visual attention, such as working on a computer or reading
How to manage your symptoms: An important first step is to identify and treat any underlying condition that may be causing your dry eyes. Dry eye triggered by a medication, for example, may be treated by switching to a similar drug that isn’t as harsh on the eyes.
Mild cases of dry eye can often be managed using over-the-counter artificial tear solutions. Choose lubricating products rather than solutions that are marketed for reducing red eye, which can cause irritation. Preservative-free artificial tear solutions are preferable because they contain fewer additives that could further irritate the eyes.
If your dry eye persists in spite of your using over-the-counter medication, you’ll need to see your ophthalmologist, who will perform one or more tests to determine whether dry eye is contributing to excessive tearing, including a Schirmer’s test. With this test, numbing drops are instilled, then a filter paper is placed inside the lower lid of the eye. After a few minutes, the paper is removed and measured for its moisture content.
Along with recommending artificial tear solutions, your doctor may prescribe special eyedrops to reduce inflammation of the tear glands. In persistent cases, treatment may include the temporary or permanent occlusion of one or two of the openings of the tear drainage system (puncta).
Blocked tear duct
Aging may cause narrowing or obstruction of any area of the tear drainage system, which helps drain tears from the eye into the nose. When the canalicular portion of the drainage system becomes constricted as a result of infection, inflammatory disorders, trauma to the eye or face, surgery, or changes to hormone levels, they can cause watery eyes and tears to leak onto the face. Symptoms may get worse after a cold or sinus infection. Also, symptoms may be more noticeable after exposure to cold, wind, or sunlight.
Related: 8 Fascinating Facts About Tears
How to manage your symptoms: If the condition persists or causes bothersome tearing or repeated episodes of infection, surgery may be required. This could take the form of a simple office procedure to dilate the puncta, or an operation called a dacryocystorhinostomy, or DCR, which creates a new channel from the tear sac to the inside of the nose, allowing tears to bypass the blocked part of the tear duct.
What else to know
Aside from conditions described here, there are also acute causes of tearing, including a scratch on the eye (abrasion), a viral infection (pink eye), or an embedded particle. If you suspect one of these, consult a doctor right away. Also seek medical help if you experience painful red eyes, discharge from your eye, persistent tearing, or tenderness around the nose or sinuses.
This article first appeared in the 2019 UC Berkeley Vision White Paper.
Also see An Eye on Eye Drops.
Published June 18, 2019