The story revolves around Hong Hae-in, a third-generation chaebol heiress of the Queens Group, and Baek Hyun-woo, the son of farmers from Yongdu-ri.

As Hae-in battles her illness, the couple is forced to confront their past mistakes, reconcile their differences, and rediscover the love that once brought them together.

Screenwriter Park Ji-eun started preparing her new project entitled Queen of Tears about two years after finishing Crash Landing on You (2019–2020), which starred Hyun Bin and Son Ye-jin.

Lee Eung-bok, who has directed hit dramas like Guardian: The Lonely and Great God (2016–2017), Descendants of the Sun (2016), Mr. Sunshine (2018), and Sweet Home (2020–present), was reportedly in talks to join the team at that time.

[47][48] The soundtrack of the series, led by music director Nam Hye-seung and featuring artists BSS, 10cm, Heize, Crush, Hong Isaac, Kim Na-young, Paul Kim, Choi Yu-ree, So Su-bin [ko], and Dori, was revealed on March 6, 2024.

[51] Queen of Tears' soundtrack album was released on April 30, 2024; it contains all of the singles and background tracks from the series.

[67] Forbes wrote that "many K-dramas end with 'happily ever after', but Queen of Tears starts that way", adding that the series "not only has a solid cast, but boasts a talented screenwriter and two directors with a track record of drama success".

[68] Tanu I. Raj of NME gave the series 3 out of 5 stars and described it as "a whirlwind office romance", which is "buoyant and decidedly comic".

[69] Geoffrey Bunting of Time described the first six episodes of the series as a "bucks convention, sending up familiar tropes of the genre for a truly unexpected viewing experience".

[70] Pierce Conran of South China Morning Post gave a score of 3/5, and wrote that "through 16 episodes threaded between tales of family woes, illness and corporate intrigue" and "Baek Hyun-woo and Hong Hae-in captured each other's hearts, as well as those of the audience at home".

[71] Joly Herman of Common Sense Media wrote that "courtesan restraint is definitely not on display in this production, which features dynasty infighting in a current setting with hints of past Korean dramas".

[81][82][83] In October 2024, CJ ENM announced that Queen of Tears would have a Turkish remake, in collaboration with O3 Medya and Dass Yapim.