Epiphora

Epiphora is overflow of tears onto the face. A clinical sign or condition that constitutes insufficient tear film drainage from the eyes in that tears will drain down the face rather than through the nasolacrimal system.^[1]

Etiology

Causes of epiphora include occular irritation and inflammation (including trichiasis and entropion) or an obstructed tear outflow tract which is divided according to its anatomical location (ie. ectropion, punctal, canalicular or nasolacrimal duct obstruction). The latter is often due to aging (a spontaneous process), infection (ie. dacryocystitis), rhinitis, and in neonates or infants, failure of the nasolacrimal duct to open.

Diagnosis

Diagnosis of epiphora is clinical by history presentation and observation of the lids. Fluorescein dye can be used to examine for punctal reflux by pressing on the canaliculi in which the clinician should note resistance of reflux as it irrigates through the punctum into the nose.

Management

If epiphora is caused by ectropion or entropion, lid repair is indicated. Punctal irrigation is also required. In infants with nasolacrimal defects, a nasolacrimal duct probe is used and a tube replacement, either temporary (Crawford) or permanent (Jones), is carried out. A surgical procedure called a dacryocystorhinostomy is done to join the lacrimal sac to the nasal mucosa in order to restore lacrimal drainage.

References

1. ^ Handbook of Ocular Disease Management - Chronic Epiphora