Epiphora is the medical term for excessive tearing, where tears overflow onto the face instead of draining normally. It happens when something disrupts the balance between how many tears your eyes produce and how efficiently those tears drain away. The cause is either overproduction of tears, a blockage somewhere in the drainage system, or both at once.
How Tear Drainage Normally Works
Your eyes constantly produce a thin film of tears to keep the surface moist and protected. Under normal conditions, tears flow across the eye with each blink and drain through two tiny openings (called puncta) at the inner corners of your upper and lower eyelids. From there, they travel through small channels into a sac near the bridge of your nose, then down through a duct that empties into your nasal cavity. That’s why your nose runs when you cry.
Epiphora occurs when any part of this system fails. Either the tear glands produce more fluid than the drainage can handle, or the drainage pathway itself is narrowed or blocked.
The Two Main Categories
Clinicians generally split epiphora into two types based on the underlying problem.
Obstructive epiphora means something is physically blocking the drainage pathway. The blockage can occur at any point: the punctal openings, the small channels leading to the tear sac, the sac itself, or the duct that empties into the nose. Age-related narrowing of the puncta is one of the most common causes in older adults, accounting for over 56% of obstructive cases in people over 60. Infections, facial injuries, tumors, or even tiny particles of debris lodged in a duct can also cause blockages.
Reflex epiphora is the paradoxical type. Here, the drainage system works fine, but something is irritating the surface of the eye and triggering a flood of reactive tears. Dry eye syndrome is a classic example: when the protective tear film breaks down, the eye compensates by producing a surge of watery tears that overwhelms the drainage system. Wind, allergies, bright light, corneal scratches, and eyelash irritation can all trigger the same reflex.
Common Causes in Adults
Age is the single biggest risk factor. As you get older, the tiny drainage openings naturally narrow, and the muscles around the eyelids that help pump tears into the drainage system lose tone. This combination makes epiphora increasingly common in people over 60.
Eyelid malposition plays a significant role. When the lower eyelid turns outward (ectropion), tears can no longer reach the drainage openings properly, and the exposed inner eyelid surface dries out, often triggering even more reflex tearing. When the eyelid turns inward (entropion), the lashes scrape against the eye surface, causing irritation, redness, and tearing.
Infections and inflammation in or around the tear sac can cause swelling that blocks drainage. Facial trauma, including fractures near the nose or cheekbone, can damage the bony canal that houses the tear duct. Certain medications are also known culprits. Some cancer-targeting drugs, particularly a class called tyrosine kinase inhibitors, list epiphora as a recognized side effect.
There’s also a rare form called gustatory epiphora, sometimes known as “crocodile tears.” This happens after nerve damage (often from Bell’s palsy) when regenerating nerve fibers accidentally reroute to the tear gland. The result is tearing triggered by chewing or eating.
Epiphora in Babies
Blocked tear ducts are remarkably common in newborns. Roughly 1 in 9 infants, about 11% of all births, are diagnosed with a congenital blockage. In most cases, a thin membrane that should have opened before birth still covers the lower end of the tear duct where it empties into the nose.
The good news is that the vast majority of these cases resolve on their own. About 47% clear up by 3 months of age, 66% by 6 months, and nearly 78% by the child’s first birthday. Parents are typically advised to gently massage the area beside the nose several times a day to help the membrane open. If tearing persists past age one, a brief procedure to open the duct is usually the next step.
How It’s Diagnosed
Figuring out epiphora itself is straightforward: tears are visibly overflowing. The real diagnostic work involves finding exactly where the problem is and whether it’s a drainage issue or an overproduction issue.
One simple test involves placing a drop of fluorescent dye in the eye and checking a few minutes later to see if it has drained into the nose. If the dye stays on the eye surface, the drainage system is likely blocked somewhere. A more involved test uses a small, thin tube inserted into the drainage opening to flush saline through the system. Where the fluid goes, or doesn’t go, reveals the location of any obstruction. If saline flows freely into the nose with no resistance, the ducts are open and the problem is likely overproduction or an eyelid issue instead.
Treatment Options
Treatment depends entirely on the cause. If dry eye or ocular surface irritation is driving reflex tearing, addressing the underlying dryness with lubricating drops or treating the inflammation often stops the overflow. If an eyelid is turning inward or outward, surgical correction of the eyelid position resolves the tearing along with it.
For blockages in the tear duct itself, the standard surgical option is a procedure called dacryocystorhinostomy, or DCR. The surgeon creates a new pathway between the tear sac and the nasal cavity, bypassing the blocked duct entirely. It has a strong track record: about 83% of patients experience full resolution of their symptoms. The procedure can be done through a small incision on the side of the nose or from inside the nose using an endoscope, and recovery typically takes a few weeks.
For narrowed punctal openings, a minor in-office procedure can widen them, sometimes with placement of a tiny plug-like stent to keep them open during healing. When medications are the cause, working with your prescribing doctor to adjust or switch the drug often resolves the tearing.
Living With Persistent Tearing
Epiphora isn’t dangerous in most cases, but it’s more disruptive than people realize. Constant tearing blurs vision, irritates the skin around the eyes, and can be socially embarrassing when others assume you’ve been crying. Chronic moisture on the skin below the eyes can lead to redness and breakdown of the skin itself. In cases involving a blocked tear sac, stagnant fluid can become infected, causing painful swelling and discharge that requires prompt treatment.
If your tearing is mild and intermittent, gently dabbing (not rubbing) with a clean tissue and keeping the eyelid skin dry is enough to manage day to day. But if tearing is constant, affects your vision, or comes with pain or discharge, it’s worth getting the drainage system evaluated, since most causes are very treatable once the specific problem is identified.