Epiphora is an overflow of tears onto the face, other than caused by normal

crying Crying is the dropping of tears (or welling of tears in the eyes) in response to an emotional state or physical pain. Emotions that can lead to crying include sadness, anger, joy, and fear. Crying can also be caused by relief from a period ...

. It is a clinical sign or condition that constitutes insufficient

tear film Tear, tears or tearing may refer to: * Tearing, the act of breaking apart a material by force * Tears, a clear liquid secreted by the tear gland in the eyes of land mammals Arts and entertainment Literature * "Tears", a poem by Edward Thomas ...

drainage from the

eye An eye is a sensory organ that allows an organism to perceive visual information. It detects light and converts it into electro-chemical impulses in neurons (neurones). It is part of an organism's visual system. In higher organisms, the ey ...

s, in that tears will drain down the face rather than through the nasolacrimal system.

Cause

Causes of epiphora are any that cause either overproduction of tears or decreased drainage of tears, resulting in tearing onto the cheek. This can be due to ocular irritation and inflammation (including

trichiasis Trichiasis ( , ) is a medical term for abnormally positioned eyelashes that grow back toward the eye, touching the cornea or conjunctiva. This can be caused by infection, inflammation, autoimmune conditions, congenital defects, eyelid agenesis an ...

and

entropion Entropion is a medical condition in which the eyelid (usually the lower lid) folds inward. It is very uncomfortable, as the eyelashes continuously rub against the cornea causing irritation. Entropion is usually caused by Genetics, genetic factors. ...

) or an obstructed tear outflow tract, which is divided according to its anatomical location (i.e., ectropion, punctal, canalicular or nasolacrimal duct obstruction). The latter is often due to aging (a spontaneous process),

conjunctivochalasis Conjunctivochalasis, also known as mechanical dry eye (MDE), is a common eye surface condition characterized by the presence of excess folds of the conjunctiva located between the globe of the eye and the eyelid margin. Symptoms Symptoms range ...

, infection (i.e.

dacryocystitis Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of the lacrimal sac. The term derives . It causes pain, redness, and swelling over the inner aspect of the lower eyelid and e ...

rhinitis Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip. The inflammation is caused by viruses, bacteria, irritant ...

, and in neonates or infants, failure of the nasolacrimal duct to open. Another cause could be poor reconstruction of the nasolacrimal duct system after trauma to the area. Cause of trauma could be facial fractures (including nasoethmoid fractures or maxillary Le Fort fractures), and soft-tissue trauma involving the nose and/or the eyelid. This condition is often frustrating or irritating. A systematic review studying the usage of

punctal plug A punctal plug, also known as tear duct plug or lacrimal plug, is a small medical device that is inserted into the Nasolacrimal duct, tear duct (puncta) of an human eye, eye to block the duct. This prevents the drainage of liquid from the eye. They ...

s for treatment of

dry eye Dry eye syndrome, also known as keratoconjunctivitis sicca, is the condition of having dry eyes. Symptoms include dryness in the eye, irritation, redness, discharge, blurred vision, and easily fatigued eyes. Symptoms range from mild and occas ...

reported a few cases of epiphora among participants.

Diagnosis

Diagnosis of epiphora is clinical by history presentation and observation of the lids.

Fluorescein Fluorescein is an organic compound and dye based on the xanthene tricyclic structural motif, formally belonging to Triarylmethane dye, triarylmethine dyes family. It is available as a dark orange/red powder slightly soluble in water and alcohol. ...

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. Dacryoscintigraphy is an imaging method used to detect obstructions in the

lacrimal apparatus The lacrimal apparatus is the physiological system containing the Orbit (anatomy), orbital structures for tears, tear production and drainage.Cassin, B. and Solomon, S. ''Dictionary of Eye Terminology''. Gainesville, Florida: Triad Publishing Co ...

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 Dacryocystorhinostomy (DCR) is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function. Process Traditional A small incision is made on the side of the nose and some bon ...

is done to join the lacrimal sac to the nasal mucosa in order to restore lacrimal drainage.

References

External links

{{Eye pathology Disorders of eyelid, lacrimal system and orbit