Epiphora

Epiphora (plural: epiphoras) represents excessive tearing of the eye and is a common clinical presentation to ophthalmological practice. It is most frequently due to an obstruction of the nasolacrimal drainage apparatus. Less commonly, overproduction of tears may be responsible. 

Epidemiology

In one of the few epidemiological studies, unilateral and bilateral epiphora each accounted for about half of the cases ².

Pathology

Etiology

In normal situations in which the eye surface becomes dry, there is reflex secretion of tears by the lacrimal glands. In certain disease states this reflex lies at the root of their pathophysiology ².

• reflex tearing
  • dry eyes
  • inflammatory diseases
  • allergies
  • primary hypersecretion of the lacrimal glands (very rare)
• decreased tear flow
  • ​eyelid malposition: entropion, ectropion and eyelid laxity
  • lacrimal drainage pathway obstruction
    • congenital
    • acquired
      • upper: e.g. punctal stenosis, canalicular obstruction, etc.
      • lower: nasolacrimal duct obstruction (NLDO)

Many cases are multifactorial

Treatment and prognosis

Management is conditional on the underlying etiology ²:

• dry eyes: warm compresses, artificial tears, flaxseed oil eye-drops
• nasolacrimal duct obstruction: mainstay is surgery
  • conjunctivodacryocystorhinostomy (CDCR)
  • dacryocystorhinostomy (DCR)
  • balloon dacryoplasty
• malposition of the eyelids: corrective surgery
• primary hypersecretion of the lacrimal glands: botulinum toxin