Watery Eyes After Blepharoplasty: Causes and Treatments

Watery eyes after blepharoplasty are one of the most frequent questions patients raise at their follow-up appointments, and it is easy to see why: you have had surgery to make your eyes look brighter, and instead they will not stop streaming. The reassuring answer is that some tearing is an expected part of healing after blepharoplasty (eyelid surgery). The important task is working out whether yours is ordinary healing or something that needs attention.

This guide explains why eyes water after eyelid surgery, how long it normally lasts, what you can do at home, which treatments exist for persistent cases and when to call your surgeon. It sits alongside our guides to blepharoplasty recovery and aftercare and dry eyes after blepharoplasty, because the two problems are closely linked. If you are still deciding whether to have surgery, our overview of the risks and complications of eyelid surgery puts watering in context.

Why Are My Eyes So Watery After Blepharoplasty?

Your eyes are watery because the delicate system that makes, spreads and drains tears has been disturbed. Eyelid surgery involves tissue right next to that system: the lids that spread tears across the eye when you blink, the tiny drainage openings at the inner corners and the muscle that pumps tears away. Swelling, stitches, ointment and a temporary change in how fully the lids close can all upset the balance, and the result is more tears on the surface than the eye can clear.

Is it normal to have watery eyes after eyelid surgery?

Yes, within limits. A tearful, gritty, light-sensitive feeling is common after both upper and lower blepharoplasty. A 2013 retrospective review of 892 blepharoplasty cases in JAMA Facial Plastic Surgery ↗ found that dry eye symptoms were reported by 26.5% of patients and chemosis (a jelly-like swelling of the white of the eye) by 26.3%, with both more frequent when upper and lower lids were operated on together^[1]. Dry eye and chemosis both make eyes feel irritated and can make them water, which is why tearing is so common early on.

What Causes Watery Eyes After Blepharoplasty?

Several different problems produce the same symptom. Working out which one applies to you is what decides the treatment.

Swelling and irritation of the eyelids

Surgery causes swelling around the eyes, and swollen lids do not sit against the eye as snugly as usual. Inflamed tissue also irritates the surface of the eye, and irritation triggers extra tear production. This is the commonest cause in the first two weeks and usually improves day by day.

Dry eye that makes the eyes water

It sounds contradictory, but a dry eye surface is a common reason for watery eyes. When the surface is dry or uncomfortable, the eye produces a flood of reflex tears that wash across the surface without lubricating it properly. After surgery, blinking can be less complete and the tear film can be unstable for a while. A 2016 review of 100 patients in JAMA Facial Plastic Surgery ↗ who had lower eyelid blepharoplasty reported new dry eye symptoms in 25 of them, although only two needed further surgery for eyelid malposition^[2]. If dryness is the underlying problem, our guide to whether blepharoplasty can cause dry eyes explains the picture in more detail.

A lower eyelid that sits slightly away from the eye

The tear drainage openings (puncta) sit on the inner edge of each eyelid and need to touch the eye surface to collect tears. If the lower lid sags or rolls slightly outwards after surgery, a condition called ectropion, or simply sits a little lower than before, the opening no longer reaches the tear lake and tears spill over the lid onto the cheek. Surgeons assess lid tightness before surgery precisely to reduce this risk, and a 2018 retrospective study of ophthalmic complications after oculofacial plastic surgery listed chemosis and lower lid ectropion among the common problems after lower blepharoplasty^[3]. Our guide to surgical solutions for ectropion covers how it is corrected.

Eyelids that do not close fully

After upper eyelid surgery, the lids may not close completely for a short time, which is called lagophthalmos. A review of blepharoplasty in Plastic and Reconstructive Surgery notes that small amounts are tolerated and usually correct within about a week, which is why lubrication matters so much early on^[4]. An eye that stays exposed is a dry eye, and a dry eye waters. Persistent incomplete closure needs review, and our article on cheap blepharoplasty abroad shows how over-resection can leave eyes that will not close.

A blocked or poorly working tear drainage system

Tears leave the eye through the puncta, tiny channels called canaliculi, the tear sac and the tear duct into the nose. Swelling can temporarily narrow this pathway, and in rare cases the system is injured. The 2018 study above recorded one canalicular laceration among its lower blepharoplasty patients^[3]. Drainage also depends on the blink: each blink squeezes the muscle around the eye and pumps tears towards the nose, so a lid that is stiff with swelling pumps less effectively.

Sensitivity to wind, light and screens

For the first weeks the ocular surface is more sensitive. Wind, bright light, air conditioning and long periods looking at a screen (when we blink less) often set off watering. This is usually the easiest trigger to manage.

How Long Do Watery Eyes Last After Blepharoplasty?

There is no single timetable, because the cause varies, but a typical pattern looks like this:

• The first two weeks: swelling, bruising, ointment and stitches make tearing and blurred vision common. Most people are at their most uncomfortable in the first few days.
• Weeks two to six: as swelling reduces, the eyes settle and tearing usually becomes occasional, often triggered by wind or tiredness.
• Months two to three: mild watering or dryness may linger, particularly after lower eyelid surgery or when both upper and lower lids were treated.
• Beyond three months: watering that is still a nuisance is no longer classed as ordinary healing and should be assessed.

Our blepharoplasty recovery guide sets out the wider timeline for swelling, bruising and return to normal activities, and our article on how long stitches take to dissolve after blepharoplasty explains why stitch irritation often fades around the same time.

Why Is Only One Eye Watering After Eyelid Surgery?

It is common for one eye to water more than the other, because swelling and healing are never perfectly symmetrical. One lid may be more swollen, one stitch line may be more irritating, or one eye may close slightly less completely. Mild one-sided tearing in the first weeks is not usually a worry.

A single eye that is still watering well after the early weeks deserves more attention. It can point to a lid that sits a little lower on that side, a partly blocked drainage channel or a dry surface on one side only, and all of these are things your surgeon can examine in a few minutes. Mention any difference between the two eyes at your follow-up, and photograph it if it comes and goes. Our article on eyelid surgery and asymmetrical eyes explains why small differences are normal, and when they are not.

Watery Eyes After Upper vs Lower Blepharoplasty

Watering can follow either operation, but the likely reasons differ. After upper eyelid surgery, tearing is mostly linked to swelling, stitch irritation and the lid not closing fully for a short while. After lower eyelid surgery, the position of the lid margin matters more, because even a small change can alter how the drainage openings meet the eye. This is also why lower lid surgery, and surgery on both upper and lower lids together, are associated with more dry eye and watering than upper lid surgery alone. A comparison of upper and lower blepharoplasty explains what each operation treats and how recovery differs.

Cosmetic and functional operations sit in the same family, and the same principles apply. If you are comparing them, see cosmetic vs functional eyelid surgery.

How to Stop Watery Eyes After Blepharoplasty

For ordinary post-operative tearing, the aim is to protect the surface of the eye while the swelling settles. Always follow the aftercare instructions you were given, and treat the following as general guidance rather than a replacement.

• Use lubricating drops and ointment as prescribed. Preservative-free artificial tears are usually recommended because they can be used often without irritating the surface. Ointment, which blurs vision, is generally used at night to protect the eyes while you sleep.
• Use gentle cold compresses in the early days if your surgeon has advised them, to reduce swelling. Never press hard on the eyes.
• Do not rub your eyes. Dab tears away with a clean tissue instead.
• Wear sunglasses outdoors to shield the eyes from wind and bright light.
• Take screen breaks and blink deliberately. Blinking fully, and often, helps the tear film spread and the tears drain.
• Keep the head raised when resting in the first days, as advised, to reduce swelling.
• Avoid contact lenses, eye make-up and swimming until you have been cleared to resume them. Our article on wearing make-up after eyelid surgery gives typical timings.
• Do not start massage or eyelid exercises unless your surgeon tells you to. The wrong technique can pull on healing tissue.

If drops are not enough or tearing is getting worse rather than better, that is the point to ring the clinic rather than wait.

Treatments for Persistent Watery Eyes After Eyelid Surgery

When watering lasts beyond the expected healing period, treatment depends on the cause found at examination. A surgeon will look at how the lids sit and close, how stable the tear film is, whether the drainage openings are in the right position and whether tears are draining. Common options include:

• Lubricating drops, gels and ointments for dry-eye-driven watering, sometimes with a short course of anti-inflammatory drops prescribed by an eye specialist.
• Treating lid swelling and stitch or scar tension where it is pulling on the lid.
• Lid exercises or massage with specific instructions, where a tight or stiff lid is the problem.
• Punctal plugs, tiny plugs that slow tear drainage and keep natural tears on the eye longer. A 2017 Cochrane systematic review of 18 randomised trials ↗ concluded that the evidence for their effect on dry eye symptoms is inconclusive, and noted that plugs themselves are commonly associated with epiphora (watering)^[5]. They are therefore used selectively, and a patient whose main problem is watering from poor drainage would generally not be offered them.
• Investigation and treatment of a blocked tear duct by an eye specialist, where tests show that tears are not draining.
• Surgical correction of lid position in the uncommon case where a lower lid sits too low or turns outwards. A 2021 study in Aesthetic Surgery Journal of 54 patients with upper eyelid ectropion, a recognised post-blepharoplasty problem, reported that the eyelid margin was well positioned in 94.4% afterwards and 29 of 32 patients surveyed said their dry eye symptoms had resolved^[6].

Where a second operation is considered, surgeons usually wait for swelling and scarring to mature, often several months, unless there is a risk to the eye. If you have had surgery elsewhere and are unhappy with the result, our service for revision blepharoplasty assesses problems after previous eyelid surgery.

When to See a Doctor About Watery Eyes After Eyelid Surgery

Most watery eyes need nothing more than time and lubrication, but some symptoms should not wait. Contact your surgeon or the clinic the same day, or use an emergency eye service or accident and emergency out of hours, if you have:

• severe or increasing pain in or around the eye;
• sudden swelling on one side, especially with pain or bulging of the eye;
• any drop in vision, new double vision or flashing lights;
• a red, sticky or discharging eye, or a temperature;
• an eyelid that will not close or a lower lid that is visibly pulling away from the eye;
• sensitivity to light that is getting worse rather than better.

Book a routine review if watering is still troublesome at around three months, is getting worse, or is only on one side. Persistent watering is not something to put up with, and it is rarely hard to identify the cause once the eye has been examined. If you are unsure, ring us: our contact details are at the end of this article.

Can You Reduce the Risk of Watery Eyes Before Blepharoplasty?

You cannot remove the risk altogether, but a careful assessment and conservative technique lower it. Factors that make post-operative dry eye and watering more likely include existing dry eye, loose lower lids, a lower lid that already shows white below the iris, hormone therapy and having upper and lower lids done together^[1]. The same review that links existing dry eye to complications stresses taking a full eye history and examining lid position and tone before surgery^[4].

• Tell your surgeon about dry or watery eyes, contact lens use, thyroid eye problems, previous eye surgery and the medicines you take.
• Expect a lid-tone assessment before lower eyelid surgery. It is a routine check, not a sign of a problem.
• Ask whether upper and lower lids need to be treated together, or whether one operation would do. Our guide to functional and cosmetic eyelid surgery explains how the decision is made.
• Choose a surgeon who will examine your eyes properly. Our advice on choosing an eyelid surgeon lists the questions to ask.
• Stop smoking as advised, and follow the aftercare plan, because both affect healing.

A small number of people are better suited to a gentler approach. Our article on non-surgical alternatives to eyelid surgery explains what these can and cannot achieve, and whether eyelid surgery changes your eye shape is worth reading before you decide.

Eyelid Surgery Before and After Photos

Seeing what a settled result looks like can be reassuring if you are in the early weeks of recovery and your eyes are still swollen. These photographs show real Centre for Surgery patients before and after upper eyelid surgery. Swelling, redness and tearing fade, and results continue to refine over several months. See more in our blepharoplasty before and after gallery.

What Happens at a Blepharoplasty Consultation at Centre for Surgery?

Whether you are planning eyelid surgery or are concerned about a result, a consultation at our CQC-regulated hospital on Baker Street starts with your eyes rather than a sales conversation. Your GMC-registered surgeon examines your lids, asks about dry eye and tearing, checks lid tone and discusses the risks, including watering, openly. The surgeon who assesses you is the surgeon who performs your operation, and we explain the options, anaesthetic choices (see blepharoplasty under local anaesthetic or asleep) and aftercare plan in full. Costs are confirmed in writing at your consultation, and finance options are available. Our guide to blepharoplasty cost in London explains what is included.

If you have heavy upper lids and are not sure whether you need eyelid surgery or a brow lift, our articles on heavy eyelids and brow lift vs blepharoplasty help you work out which concern you have. If you are planning more than one procedure, see combining blepharoplasty and rhinoplasty.

Frequently Asked Questions

Watery Eyes After Eyelid Surgery in London

If your eyes are still watering after eyelid surgery, or you are considering blepharoplasty and want an honest discussion of the risks, a consultation with one of our surgeons will examine your eyes properly and explain what is happening and what can be done. Find out more about eyelid surgery at Centre for Surgery.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Prischmann J, Sufyan A, Ting JY, Ruffin C, Perkins SW. Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series. JAMA Facial Plastic Surgery 2013;15(1):39–46. doi:10.1001/2013.jamafacial.1 ↗
2. Sultan B, Genther DJ, Perkins SW. Measurement of change in lower eyelid position in patients undergoing transcutaneous skin-muscle flap lower eyelid blepharoplasty. JAMA Facial Plastic Surgery 2016;18(6):429–435. doi:10.1001/jamafacial.2016.0673 ↗
3. Baek JS, Kim KH, Lee JH, Choi HS. Ophthalmologic complications associated with oculofacial plastic and esthetic surgeries. Journal of Craniofacial Surgery 2018;29(5):1208–1211. doi:10.1097/SCS.0000000000004515 ↗
4. Trussler AP, Rohrich RJ. MOC-PSSM CME article: blepharoplasty. Plastic and Reconstructive Surgery 2008;121(1 Suppl):1–10. doi:10.1097/01.prs.0000294667.93660.8b ↗
5. Ervin AM, Law A, Pucker AD. Punctal occlusion for dry eye syndrome. Cochrane Database of Systematic Reviews 2017;6:CD006775. doi:10.1002/14651858.CD006775.pub3 ↗
6. Cho IC, Kim BJ, You HJ, Tark WH. Surgical correction of upper eyelid ectropion presenting dry eye symptoms. Aesthetic Surgery Journal 2021;41(1):NP1–NP9. doi:10.1093/asj/sjaa143 ↗