{ "schema_version": 1, "kind": "condition", "id": "watery-eye", "name": "Watery eye (epiphora)", "category": "chronic", "sources": "ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FS03.00 - condition scope only, no dose · Nasolacrimal Duct Obstruction - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK532873/ · Hypromellose ophthalmic solution, US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) · Hypromellose ophthalmic solution (Vista Gonio Eye Lubricant), US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) - instil 1 or 2 drops in the affected eye(s) as needed.", "review_status": "reviewed", "verified_against": "Watery eye (epiphora) - disease-level clinical article (watery-eye-full.txt) · Hypromellose ophthalmic solution, US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) · Hypromellose ophthalmic solution (Vista Gonio Eye Lubricant), US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) - instil 1 or 2 drops in the affected eye(s) as needed.", "verified_date": "2026-08", "treatments": [ { "id": 1967, "generic": "Hypromellose", "line": 1, "is_adjunct": false, "form": "eye", "strength_mg": null, "adult_dose": "1 or 2 drops into the affected eye as needed", "adult_duration": "For as long as the surface irritation lasts; review if the watering does not settle", "dose_source": "Hypromellose ophthalmic solution (Vista Gonio Eye Lubricant), US over-the-counter label, Directions (DailyMed SetID 00da365d-2988-9c9e-e063-6294a90a8931) - instil 1 or 2 drops in the affected eye(s) as needed.", "rationale": "The epiphora article describes evaporative loss from an unstable tear film stimulating the lacrimal gland to over-produce, so a dry eye presents as a watering one; it reports dry eyes as the cause in 40% of patients in a tertiary oculoplastic practice, and says treating surface irritation with lubrication can reduce the reflex tearing. It also puts teaching a good lubrication technique among the things that matter most for these patients.", "cautions": [ "Lubrication treats only the watering that comes from a dry, irritated surface. It does nothing for a blocked nasolacrimal duct, an in-turned or out-turned lid, or a weak lacrimal pump - the article puts punctal, canalicular and nasolacrimal obstruction together at well over half of chronic cases, and each needs a surgical opinion.", "Review what the patient is already instilling. The article names anti-glaucoma drops, pilocarpine, phospholine iodide and idoxuridine among the medicines that can themselves obstruct the lacrimal drainage.", "One-sided watering points to a local cause; both eyes watering is more often over-production from allergy or keratoconjunctivitis.", "If the watering persists after a fair trial of lubrication, refer - the article's options from there are punctoplasty, balloon dacryoplasty or dacryocystorhinostomy, chosen by where the obstruction sits." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "1 or 2 drops as needed, the same as an adult. Watering in an infant is usually congenital nasolacrimal duct obstruction, which is managed by massage and hygiene rather than by a lubricant.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "HYDROBLEND 0.32% EYE DROPS 10*0.5 ML SDU", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL ADVANCED PHARMACEUTICALS (GAP) > MONOPHARMA PHARMACEUTICALS", "price_egp": 15.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GENTEAL EYE DROPS 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOVARTIS > NOVARTIS SCIENTIFIC OFFICE", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OPTILUBRIC 0.32% EYE DROPS 30*0.5 ML SDU", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 96.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HYDROBLEND 0.32% EYE DROPS 30*0.5 ML SDU", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL ADVANCED PHARMACEUTICALS (GAP) > MONOPHARMA PHARMACEUTICALS", "price_egp": 108.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "watery-eye" }, { "id": 1968, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Overflow of tears from poor drainage (nasolacrimal duct blockage, eyelid malposition) or from reflex overproduction (irritation, allergy, infection). Since the right response depends on the cause, there is no single drug to point to here; a GP's role is examining for a treatable cause and referring (for example for duct probing or lid surgery) when indicated.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "Overflow of tears from poor drainage (nasolacrimal duct blockage, eyelid malposition) or from reflex overproduction (irritation, allergy, infection). Since the right response depends on the cause, there is no single drug to point to here; a GP's role is examining for a treatable cause and referring (for example for duct probing or lid surgery) when indicated.", "cautions": [ "The drug rows above are what the treating service gives. They are here so that the referral is an informed one and so the GP can recognise the regimen the patient comes back on - not as permission to start it without the referral.", "RED FLAG - A firm, hard, non-fluctuant medial canthal mass or bloody tear discharge indicates a possible lacrimal sac tumor requiring urgent specialist evaluation.", "RED FLAG - Erythema, swelling, and tenderness over the lacrimal sac indicate acute dacryocystitis requiring prompt treatment and evaluation.", "A watery eye accompanied by pain, redness, or vision change suggests infection or another eye disease rather than simple duct blockage, and in an infant a persistently watery, mucky eye since birth suggests congenital duct obstruction." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The drug rows above are instilled, not dosed by weight. The referral threshold and the safety-netting are the same at any age.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "watery-eye" } ] }