Why do I experience tearing while eating during work?

Gustatory Lacrimation (Tearing While Eating)

You are experiencing gustatory lacrimation, commonly known as "crocodile tears," which is an aberrant reflex where eating triggers tear production instead of the normal salivary response alone.

What Is Happening

• Gustatory lacrimation occurs when nerve fibers that should stimulate salivation instead aberrantly stimulate the lacrimal (tear) glands during eating 1
• This represents a misdirection of nerve signals, where the facial nerve pathways controlling salivation and lacrimation become cross-wired 1
• The condition can be congenital (present from birth) or acquired (developing after injury or nerve damage) 1

Most Common Causes in Adults

Acquired Gustatory Lacrimation

• Facial nerve injury or Bell's palsy is the most common cause in adults, where nerve regeneration after damage creates aberrant connections between salivary and lacrimal pathways 1
• Post-surgical complications affecting the facial nerve region can trigger this phenomenon 1
• The aberrant nerve regeneration typically occurs weeks to months after the initial injury 1

Congenital Forms

• Congenital aberrant tearing is rare but associated with developmental abnormalities affecting cranial nerves, particularly when the facial nerve, sixth nerve, and lacrimal nucleus are disrupted during embryonic development at 4-6 weeks 1
• This form is often associated with other cranial nerve abnormalities like Duane syndrome or Möbius sequence 1

When to Seek Medical Evaluation

You should see an ophthalmologist or neurologist if:

• You have any history of facial weakness, asymmetry, or Bell's palsy 1
• The tearing is unilateral (one eye only), which suggests nerve pathway disruption 1
• You have other neurological symptoms like facial numbness, weakness, or difficulty with eye movements 1
• The symptom developed suddenly or after facial trauma/surgery 1

Diagnostic Approach

• Schirmer testing can objectively measure tear production at baseline and after eating to confirm gustatory lacrimation 1
• A thorough neurological examination focusing on cranial nerve function, particularly the facial nerve (CN VII), is essential 1
• History should specifically address any prior facial nerve injury, Bell's palsy, or surgical procedures in the facial region 1

Management Options

Conservative Management

• No treatment is necessary if the tearing is mild and not bothersome, as this is a benign condition that does not threaten vision or health 2
• Using tissues or napkins during meals is often sufficient for mild cases 2

Medical Treatment

• Botulinum toxin injections into the lacrimal gland can effectively reduce tear production in cases where tearing is socially embarrassing or functionally problematic 2
• Anticholinergic medications may reduce both salivation and lacrimation but have systemic side effects that often limit their use 2

Surgical Options

• Surgical interruption of lacrimal gland innervation is reserved for severe, refractory cases but carries risks of permanent dry eye 2

Common Pitfalls to Avoid

• Do not assume this is simply "watery eyes" from dry eye syndrome, which is the most common cause of tearing complaints but presents differently with constant irritation rather than meal-specific tearing 2, 3
• Do not ignore unilateral tearing with eating, as this strongly suggests acquired nerve injury requiring neurological evaluation 1
• Do not pursue aggressive treatment without confirming the diagnosis, as many patients adapt well to mild gustatory lacrimation and intervention risks creating worse problems like dry eye 2

Prognosis

• Congenital gustatory lacrimation is permanent but stable and does not worsen over time 1
• Acquired forms may improve partially over 6-12 months as nerve regeneration stabilizes, though complete resolution is uncommon 1
• The condition does not cause vision loss or eye damage and is primarily a quality-of-life issue 2