The Etiology of Epiphora: A Multifactorial Issue

Abstract: Objectives: Epiphora (excess tearing) is a common complaint among patients visiting ophthalmology clinics. The etiology of epiphora in patients presenting to a primary ophthalmologist might be very different compared to those referred to an oculoplastic unit. Purpose: To describe the etiology of epiphora in patients referred to an oculoplastics clinic. Methods: A retrospective, observational study of all consecutive referrals to oculoplastic service for epiphora in 2011–2012. Slit-lamp examination, eyelid position, dry eye tests, ocular surface pathology, the patency of the nasolacrimal system, and punctal aperture were evaluated. Results: A total of 445 eyes of 280 patients (205 men; 46.1%) participated. The mean age was 69.4 ± 15 (range 15–96) years. Bilateral epiphora occurred in 165 (58.9%) patients and unilateral in 115 (41.1%). The etiologies referred for epiphora were lower lid malposition (33.3%), nasolacrimal/canalicular obstruction (29%), multifactorial (22%), punctal stenosis (11%), and reflex tearing (4.7%). Women were younger than men (p < 0.0001). More women had punctal stenosis compared to men (34.6% versus 22.4%, p = 0.01), and more men had eyelid malposition than women (39.5% versus 27.9%, p = 0.005). Conclusions: Women with epiphora tend to present with nasolacrimal duct obstruction and punctal stenosis at younger ages, and unilaterally more often than men. Men with epiphora were older, with more cases attributed to laxity of the lower eyelid. Multiple etiologies frequently need to be addressed to achieve optimal results in treating epiphora.