Epiphora: Abnormal Tearing
Ophthalmology: Lacrimal System Disorders
1. Categorization by Mechanism
Epiphora is defined as an overflow of tears onto the face, resulting from two primary mechanisms:
- Hypersecretion: Reflex tearing due to ocular surface irritation (e.g., dry eye, trichiasis, or corneal foreign body).
- Impaired Outflow: Obstruction of the lacrimal drainage system (e.g., nasolacrimal duct obstruction, punctal stenosis).
2. Clinical Assessment
| Diagnostic Test | Clinical Significance |
|---|---|
| Fluorescein Dye Disappearance Test | Delayed clearance of dye from the tear film suggests an outflow obstruction. |
| Syringing & Probing | Directly assesses the patency of the canalicular and nasolacrimal system. |
| Jones Dye Test | Differentiates partial from complete nasolacrimal duct obstruction. |
3. Management & High-Yield Pearls
- Management: Depends entirely on the cause. Address surface disease for hypersecretion; surgical intervention (e.g., Dacryocystorhinostomy/DCR) is often required for mechanical nasolacrimal duct obstruction.
- Red Flag: Chronic unilateral epiphora, especially if accompanied by a firm mass near the medial canthus, mandates ruling out lacrimal sac malignancy.
- Educational Resource: For detailed anatomy of the lacrimal system, diagnostic algorithms, and clinical practice questions, visit mymedschool.org.