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About six months ago I started crying uncontrollably. These were not tears of sadness or frustration, just an annoying watery stream that was a constant inconvenience. My make-up smudged, driving was challenging on bright days and it got a bit tiresome having to explain to strangers that, even though I am a 51-year-old menopausal working mum, I was not having an emotional meltdown.
Resolved to take a deep dive into the cause of my eye streaming (a condition I’ve discovered is called epiphora), I consulted top oculoplastic surgeon Naresh Joshi at the Cromwell Hospital in London. He told me epiphora is a common condition that can be caused by several issues. So, if you are reading this through wet eyes, read on and I’ll explain.
Mr Joshi says the most common culprit is inflammation caused by evaporative dry eye disease. ‘When the surface of the eye dries out, it sends a distress signal that causes overproduction of tears, though these are often poor quality and don’t lubricate the eye properly.
‘It may sound odd but dry eyes and watery eyes are often two sides of the same coin. If your tear film is poor (due to a low-quality oil or mucus layer, which often happens with age) your eyes may react by producing more watery tears to compensate.’
Dr Rachna Murthy is an oculoplastic surgeon and UK ambassador for TFOS, the Tear Film & Ocular Surface Society, (tearfilm.org), an international community of eye-care specialists who have an interest in dry and watery eyes. She adds: ‘One in ten people in the UK suffers from rosacea (an inflammatory skin disease) and 80 per cent of rosacea sufferers have ocular rosacea, which can include blepharitis (an inflammation of the eyelids and oil glands around the lids and lashes), and this also causes streaming.’
I think I might check this box as I have mild rosacea. Dr Murthy tells me the arrival of winter will not help us streamers either, as cold air and wind can irritate the sensitive corneal surface of the eye, leading to watery eyes even in healthy people.
Throw menopause into the mix and things get blurrier. As we grow older, tear drainage often slows, eyelids loosen and sag and tear quality worsens, creating a perfect storm for tear overflow.
As we grow older, tear drainage often slows, eyelids loosen and sag and tear quality worsens, creating a perfect storm for tear overflow (picture posed by model)
TRY THESE EASY LIFESTYLE TWEAKS
Taking omega-3 supplements and eating a nutrient-rich diet packed with oily fish and nuts can help to reduce rosacea and improve blepharitis. Cut down on screen time, too.
Practise good lid hygiene. A warm compress followed by a gentle wipe along the lash line helps clear away oils and bacteria, keeping the glands healthy and reducing irritation and watering.
Wear wraparound glasses when cycling or out in the sun to reduce stimulation of the tear reflex.
Avoid eye drops that contain preservatives as they can further irritate eyes.
‘Around menopause, falling oestrogen levels can make the tear film unstable and the eyes drier, which then paradoxically causes watery eyes,’ says Mr Joshi. ‘Interestingly, large studies show that women on hormone replacement therapy (HRT) – particularly oestrogen-only HRT – may have more dry-eye symptoms.’
Dr Murthy cautions that the trend of using a vaginal oestrogen cream around the eyes to soften crow’s feet can worsen watery eyes.
However, after a thorough eye exam with Mr Joshi, I learn that the cause of my watery eyes is not what I expected. I have narrowed tear ducts and poor tear drainage (another common cause of watery eyes). He explains that each eyelid has a punctum – a tiny hole that drains tears into the nose – but with age these openings can narrow or block. The eyelid muscles that help pump tears into the duct may also weaken, especially if the lids droop slightly away from the eye.
Mr Joshi recommends that I have minor punctal surgery, which involves inserting tiny silicone plugs into my tear ducts to enlarge them. It sounds dramatic but, thanks to some anaesthetic eyedrops and local anaesthetic, I don’t feel a thing. There’s no downtime and two weeks after having the plugs removed the taps have been turned off and my face is streak-free.
The takeaway? Watery eyes are rarely just a nuisance; they’re usually a sign of imbalance in your tear system. The good news is that once the underlying reason is identified, treatment is often straightforward. From simple lifestyle tweaks to clever devices like punctal plugs or minimally invasive treatments, modern eye care can almost always help you stem the tears. The unintentional ones, at least.
Olivia Falcon is the founder of @theeditorslist
THE PRODUCTS 
A brilliant at-home soother containing hypochlorous acid (a weak acid found in white blood cells, which has powerful antimicrobial properties). Spritz it on closed eyelids two to three times per day to reduce inflammation.
Better than an eye compress at holding the optimum temperature to restore eye comfort, this wand’s gentle massage mode promotes circulation of excess fluid to reduce puffiness. Red LED lights help smooth crow’s feet.
As tear production slows while we sleep, this soothing overnight ointment can help keep eyes hydrated for up to six hours. Its nourishing formula contains vitamin A, a natural component of the tear film.
THE PROCEDURES Punctal or lacrimal surgery
If tear ducts are narrowed or blocked, a minor procedure can widen the opening using punctal plugs to enlarge them, which are then removed. In other cases, tiny stoppers are kept in place either to conserve tears (for people whose watery eyes are due to dry eyes) or to prevent the drainage opening from closing up again after surgery. In more severe cases, surgeons can create a new drainage pathway from the tear sac into the nose with a procedure called dacryocystorhinostomy (DCR).
Available on the NHS or from £160 privately.
Tear-gland Botox
In rare cases where the tear glands are overactive, a tiny dose of Botox can be injected into the lacrimal gland to reduce tear production. The effect usually lasts a few months and must be done by an experienced oculoplastic surgeon, as excessive reduction can cause dryness.
Available on the NHS or from £350 privately.
OptimEyes
This treatment for evaporative dry eye disease is great for rosacea sufferers. It combines IPL (Intense Pulsed Light) to target diluted blood vessels in the face, which feed the inflamed eyelid vessels, and blue light to reduce bacteria around the eyelid. The process is pain-free and there is no downtime. Patients can often be weaned off eye drops and get back to using contact lenses afterwards.
£1,600 for four 60-minute treatments, each a month apart (facerestoration.com).