Constant watering in adults: when the answer is a DCR
An eye that runs all day is not always producing too many tears; sometimes it cannot drain them. What a dacryocystorhinostomy is and in which cases it solves the problem at its root.
By Dr. Miguel Ángel Olivardía Moreno · · Updated 3 de agosto de 2026
There is one complaint that patients tend to play down for years: the eye that waters constantly. It is a nuisance when reading, it means wiping your cheek continuously, it blurs vision and, over time, irritates the skin of the eyelid.
People live with it assuming that is just how it is. Often there is a solution.
Producing too much or draining too little
Tears are produced without pause to keep the cornea lubricated and transparent. They then have to drain: they enter through the lacrimal puncta at the inner corner of the eye, pass along the canaliculi, reach the lacrimal sac and descend through the nasolacrimal duct into the nose.
When that circuit is interrupted at some point, the tear accumulates and overflows. This is called epiphora.
But there is a second possibility that should always be ruled out: a dry eye also waters, by reflex. If the tear film is of poor quality, the surface becomes irritated and triggers a watery, abundant tear that does not lubricate.
They are two opposite mechanisms with the same symptom. Operating on the tear duct of a patient whose real problem was dry eye solves nothing. Hence the preoperative assessment is decisive.
Causes of blockage in adults
- Involutional, related to age: the most frequent, especially in women.
- Chronic inflammatory or infectious processes.
- Facial trauma, particularly with fracture of the nasal bones.
- Previous nasal or sinus surgery.
- Some medications, including certain cancer treatments.
- Tumours, uncommon but which must be ruled out.
What is examined beforehand
- Examination of the eyelid margin and of the position of the lacrimal puncta. Sometimes the problem is not blockage but that the punctum is not in contact with the tear film, as happens in ectropion.
- Probing and irrigation of the system, to locate where the blockage is.
- Assessment of the ocular surface, to rule out a dry eye with reflex tearing.
- Imaging in selected cases.
- Nasal examination, because the final destination of the drainage is the nose and its anatomy shapes the surgery.
What a dacryocystorhinostomy is
When the blockage is in the nasolacrimal duct, it cannot be cleared in a lasting way. The solution is to create a new drainage route: the lacrimal sac is connected directly to the nasal cavity, bypassing the blocked segment.
That is a dacryocystorhinostomy, usually abbreviated to DCR.
External approach. Through a small incision beside the nose. It is the classic approach, with very consistent results. It leaves a skin scar that generally settles well.
Endonasal approach. Through the nasal cavity, with endoscopic instruments. It leaves no visible scar.
The choice depends on the cause of the blockage, on the patient's nasal anatomy, on whether there has been previous surgery and on the features of the case.
In many cases a temporary silicone tube is placed to keep the new passage open while it heals; it is removed in clinic after a few weeks.
Recovery
- Moderate discomfort, generally well tolerated.
- Nasal congestion and slight bleeding during the first few days.
- It is advised to avoid blowing your nose hard and heavy exertion.
- Nasal washes as instructed.
- Scheduled check-ups and removal of the tube when appropriate.
Why it is not worth letting it go
Beyond the daily nuisance, a blocked tear duct keeps tears stagnating in the sac. That stagnation favours infection: dacryocystitis, which shows up as a red, hot, painful lump at the inner corner of the eye.
It can recur, requires antibiotic treatment and, in uncommon cases, spread to the neighbouring tissues. In addition, a permanent reservoir of bacteria right next to the eye is a risk factor if eye surgery — such as for cataract — is ever needed.
Resolving the blockage removes that focus.
