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 pain. Emotions that can lead to crying include sadness, anger, and even happiness. The act of crying has been defined as "a complex secr ...

. It is a

clinical sign Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...

or condition that constitutes insufficient

tear film Tears are a clear liquid secreted by the lacrimal glands (tear gland) found in the eyes of all land mammals. Tears are made up of water, electrolytes, proteins, lipids, and mucins that form layers on the surface of eyes. The different types of ...

drainage from the eyes, 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 and ...

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 genetic factors. This is d ...

) 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 aMechanical 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 fro ...

, infection (i.e.

dacryocystitis Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. The term derives from the Greek ''dákryon'' ( tear), ''cysta'' (sac), and ''-itis'' ( inflammation). It ...

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, irrita ...

, 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 A Le Fort fracture of the skull is a classic transfacial fracture of the midface, involving the maxillary bone and surrounding structures in either a horizontal, pyramidal or transverse direction. The hallmark of Lefort fractures is traumatic ''pt ...

), 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 plugs for treatment of dry eye 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 triarylmethine dyes family. It is available as a dark orange/red powder slightly soluble in water and alcohol. It is widely used ...

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 orbital structures for tear production and drainage.Cassin, B. and Solomon, S. ''Dictionary of Eye Terminology''. Gainesville, Florida: Triad Publishing Company, 1990. It consist ...

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

External links

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