If I have dry eye, why do my eyes water?

Women wiping her dry eyes

It might not make sense, but dry eye syndrome often leads to watery eyes. Dry eye is all about the composition of your tears. Having a lot of tears with the wrong chemical composition can give you the feeling of teary, watery eyes, because this is your body’s own way of trying to correct the problem; however, it is not effective and leaves you with too many tears that are not doing the job. 

To help explain this phenomenon, we spoke with Dr. Kimberly Riordan, an optometrist with Florida Eye Specialists and the Head of the Dry Eye Center for Excellence. According to Dr. Riordan, when your tears are not balanced, your brain kicks in mechanisms to help lubricate your eyes. This is called reflex tearing.

“It’s the body’s way of trying to help, but we get stuck in this vicious cycle,” Dr. Riordan explained. “What happens is that your body creates an overabundance of tears that don’t stick to the surface of your eyes, and they drain out. Your brain says your eyes are still dry, so it produces more tears. Until we can restore the balance, you’ll be stuck in that cycle.”

What Causes Dry Eye?

“To treat watery eyes, the first thing you need to do is determine the underlying cause with a proper eye exam from your eye doctor,” said Dr. Riordan. “Dry eye can be somewhat of a misnomer. ‘Tear film dysfunction’ or ‘insufficient tear film’ might better describe the condition.” She explained that our tear film is made of three key components: oil, water, and mucous. 

“We need the mix to stay balanced for healthy tears,” she said. “Dry eye occurs when there’s an imbalance. Something from the mix of oil, water, and mucous is lacking, or something is being overproduced. Our goal in dry eye treatment is to restore balance and reduce inflammation to get your eyes feeling better.” 

According to Dr. Riordan, there are many potential underlying causes of tear issues. “It’s important to know that the cause isn’t always dry eye,” she explained. “For example, some people can get blockages in their tear ducts. Another issue can be blepharitis, an eyelid condition we can treat with specialized eyelid cleanings. If you have a meibomian gland dysfunction, we have treatments like LipiFlow that can help improve symptoms. It’s also possible to have dry eye and another issue — there could be multiple things going on! We will determine this during your exam.” 

Can Allergies Cause Dry Eye?

According to Dr. Riordan, allergies can also cause an imbalance or inflammation in our tear film. Allergies can prevent our tears from functioning how they should and put our delicate meibomian glands out of balance. “When we have a high inflammatory load from allergies, that can also cause symptoms, one of them being too much tearing,” she explained.

However, Dr. Riodan says it’s important to tell the difference between allergies and dry eye for proper treatment. Self-treating with allergy medications like antihistamines, which can dry out the eyes, can be a mistake.

“A lot of people chalk their symptoms up to allergies. So they start taking allergy medications over the counter for allergy symptoms, but they don’t realize those medications just dry the eye out more,” Dr. Riordan said. “So we have to figure out, how much of the issue is allergies, and how much is dry eye? We don’t recommend our patients use oral antihistamine medications to treat a tear issue that should be treated locally in the eye.”

Fortunately, Dr. Riordan said it’s easy to determine whether a patient is dealing with allergies. First, she asks patients about their history of allergies. “They often have other symptoms like stuffy nose, sneezing, and congestion,” she said. Then, she conducts an exam. “When we look at the eyes, we can see signs of allergies to confirm this. There are tests we can do that sample the tears and look for those known markers of inflammation and allergies.”

Ways to Treat Dry Eye

Should You Use Eye Drops Or Artificial Tears?

It might sound counter-intuitive, but for many patients, the best solution for watery dry eyes is artificial tears or eye drops. These drops will wash away the concentrated real tears, soothing the surface of the eye and protecting it.

However, Dr. Riordan explained that patients should be mindful of how often they use eye drops and which type of drops they purchase if they get them over the counter.

“You need to be aware that tears with preservatives can be overused. If you use them regularly — four or more times per day, they can irritate the eyes more. You can make the condition worse,” Dr. Riordan said. “I recommend preservative-free tears because you can’t overuse those.” 

Click here for the best eye drops Dr. Riordan recommends. She said that no single brand works best for all forms of dry eye, and it’s common to try a few different brands before finding one that works best for you. 

Nasal Treatments

For patients who don’t like eye drops, Dr. Riordan says there are new nasal treatments that help dry eye through neural stimulation. “It creates a feedback loop to produce good, healthy tears,” she explained. One product she mentioned is Tyrvaya, which is chemically induced into the nose. Another is iTear100, a device that’s used externally to hit the correct nerve and begin the natural tear production process. 

Symptoms of Dry Eye Syndrome

Dry eye disease can make your eyes uncomfortable, blurry and even painful, but you don’t have to live with this common condition. Don’t ignore the symptoms of dry eye — our eye care experts are here to help with a personalized treatment plan for you.

  • Scratchy eyes
  • Blurred vision, especially after long periods of staring at a screen
  • Watery eyes
  • Itching or burning eyes
  • Stringy mucus coming from the tear ducts
  • Feeling like there’s something in the eye
  • Sensitivity to light
  • Redness in the whites of the eyes

Visit Florida’s Top Dry Eye Experts

Schedule an appointment with Dr. Kimberly Riordan at our Dry Eye Center in Jacksonville, FL to begin creating a treatment plan that best suits your type of dry eye. Or, visit another specialist at our offices in Fernandina Beach, St. Augustine, Palm Coast, or Ormond Beach.