[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Approach by symptom](https://durgical.com/en/ophthalmology/areas/approach/) › The watering eye (epiphora)

# The watering eye (epiphora)

- Clinical approach

A watery eye makes too many tears or drains them poorly. In babies it is usually a blocked duct that opens alone; with photophobia it can be glaucoma.

Updated Nov 5, 2026

**See it in 3D:** [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/) · [Lacrimal gland](https://durgical.com/en/anatomy/lacrimal-gland/) · [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)

## Key points

- Infant with sticky watery eye = congenital duct obstruction; most resolve by 1 year.
- Tearing + photophobia + large cloudy cornea = congenital glaucoma, urgent.
- Dry eyes often water.
- Swelling below the medial canthal tendon = dacryocystitis.

## What it is

Epiphora is tears spilling over the lid. Either too many tears are made, often as a reflex to irritation (dry eye, blepharitis, an inturned lid or lash), or drainage fails: a narrow punctum, an outturned or lax lower lid, or a blocked nasolacrimal duct. In infants, congenital nasolacrimal duct obstruction is common and usually resolves in the first year. Congenital glaucoma is the rare cause that must not be missed.

## Red flags

- An infant with tearing, light sensitivity and a large or cloudy cornea: congenital glaucoma.
- A red, painful swelling below the inner corner of the eye: acute dacryocystitis.
- Bloody tears or a firm mass at the inner corner: lacrimal sac tumour.
- A red, sticky eye in a newborn in the first weeks: neonatal conjunctivitis.
- Tearing with reduced vision or pain.

## Step-by-step approach

- Ask about onset (birth or later), one or both eyes, discharge, itch and grittiness.
- Look at the lids: position (entropion, ectropion), laxity, the punctum, lashes touching the eye.
- Look for dry eye and blepharitis: paradoxically, dry eyes water.
- Press over the lacrimal sac: reflux of mucus or pus means a blocked duct.
- In infants, look at the corneal size and clarity and ask about light sensitivity.

## Causes of a watering eye

| Cause | Mechanism | Clue |
| --- | --- | --- |
| Congenital nasolacrimal duct obstruction | Drainage | From the first weeks, sticky lashes, white eye |
| [Acquired nasolacrimal duct obstruction](https://durgical.com/en/conditions/dacryocystitis-and-nasolacrimal-duct-obstruction/) | Drainage | Older adult, mucus on pressing the sac |
| Ectropion or lid laxity | Drainage | Lower lid turned out or loose |
| [Dry eye or blepharitis](https://durgical.com/en/conditions/dry-eye-disease/) | Reflex | Grittiness, worse with reading or screens |
| [Entropion or trichiasis](https://durgical.com/en/conditions/trachoma/) | Reflex | Lashes rubbing the cornea |
| Congenital glaucoma | Reflex | Light sensitivity, large cloudy cornea |

## Keys to the differential

- Most congenital duct obstructions open alone by the age of one year.
- Trachoma scarring turns the lashes in (trichiasis) and still causes blindness in parts of Latin America.
- Acute dacryocystitis can spread to orbital cellulitis.

## Next step / Initial management

- Congenital duct obstruction with a white eye: lacrimal sac massage and lid hygiene; refer for probing if it persists beyond about 12 months.
- Infant with tearing, light sensitivity or a large cloudy cornea: urgent paediatric ophthalmology for congenital glaucoma.
- Acute dacryocystitis: systemic antibiotics, warm compresses and ophthalmology; dacryocystorhinostomy once the infection settles.
- Adult: treat dry eye and blepharitis; refer lid malposition and persistent duct obstruction routinely, and bloody tears or a mass urgently.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the usual course of congenital nasolacrimal duct obstruction?

Most cases open spontaneously in the first year of life; probing is offered if it persists.

## Which signs in a tearing infant suggest congenital glaucoma?

Light sensitivity, a large cornea and a cloudy cornea; it needs urgent ophthalmology.

## Why can a dry eye water?

Because irritation of the dry surface triggers reflex tearing of poor-quality tears.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/the-watering-eye/)

## Connections

## See it in 3D 3

The structures of Durgical's 3D anatomy where it is found.

- [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/)
- [Lacrimal gland](https://durgical.com/en/anatomy/lacrimal-gland/)
- [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)

## Related 4

- [Tear production and drainage](https://durgical.com/en/ophthalmology/tear-production-and-drainage/)
- [The tear film and ocular surface](https://durgical.com/en/ophthalmology/the-tear-film-and-ocular-surface/)
- [The tearing or red-eyed infant](https://durgical.com/en/ophthalmology/the-tearing-or-red-eyed-infant/)
- [Neonatal conjunctivitis and its prevention](https://durgical.com/en/ophthalmology/neonatal-conjunctivitis-and-its-prevention/)

## Related conditions 4

- [Dacryocystitis and nasolacrimal duct obstruction](https://durgical.com/en/conditions/dacryocystitis-and-nasolacrimal-duct-obstruction/)
- [Dry eye disease](https://durgical.com/en/conditions/dry-eye-disease/)
- [Trachoma](https://durgical.com/en/conditions/trachoma/)
- [Conjunctivitis](https://durgical.com/en/conditions/conjunctivitis/)

[← All of ophthalmology](https://durgical.com/en/ophthalmology/)

Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.

Sources: [Epiphora](https://www.ncbi.nlm.nih.gov/books/NBK557449/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Congenital Nasolacrimal Duct Obstruction](https://www.ncbi.nlm.nih.gov/books/NBK559267/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Dacryocystitis](https://www.ncbi.nlm.nih.gov/books/NBK470565/) (StatPearls Publishing (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/ophthalmology/the-watering-eye/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/the-watering-eye/