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Epiphora – Causes, Symptoms & Treatment

Epiphora is the excessive overflow of tears onto the face, caused by impaired tear drainage or overproduction of tears. It is a common eye symptom with various underlying causes.

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Things worth knowing about "Epiphora"

Epiphora is the excessive overflow of tears onto the face, caused by impaired tear drainage or overproduction of tears. It is a common eye symptom with various underlying causes.

What is Epiphora?

Epiphora refers to the involuntary overflow of tears down the cheek, not caused by emotional crying. The term originates from the Greek word meaning "overflow" or "sudden flow." Epiphora is not a disease in itself but a clinical symptom that can point to a variety of underlying eye or nasal conditions. It affects people of all ages, though it is particularly common in infants and older adults.

Causes

The causes of epiphora are broadly divided into two main categories:

Impaired Tear Drainage

Narrowing or blockage of the nasolacrimal duct (nasolacrimal duct stenosis or obstruction)
Dacryocystitis (infection of the tear sac)
Scarring after trauma or surgery
Tumors affecting the lacrimal drainage system
Age-related eyelid laxity, such as ectropion (outward-turning eyelid) or entropion (inward-turning eyelid)

Excessive Tear Production (Hypersecretory Epiphora)

Conjunctivitis (inflammation of the conjunctiva)
Allergic reactions (e.g., hay fever)
Corneal diseases or injuries
Dry eye syndrome (reflex tearing)
Foreign bodies in the eye
Exposure to smoke, wind, or bright light
Certain medications as a side effect

Symptoms

The hallmark symptom of epiphora is the visible overflow of tears beyond the eyelid margin. Associated symptoms may include:

Redness and irritation of the eyes
Blurred vision caused by an unstable tear film
Skin irritation or eczema below the eye from constant moisture
Crusting at the eyelid margin, especially upon waking
Pain or swelling near the inner corner of the eye (if the tear sac is inflamed)

Diagnosis

Epiphora is diagnosed by an ophthalmologist using a combination of clinical examinations:

Slit-lamp examination: Detailed assessment of the anterior eye segment and lacrimal puncta
Fluorescein staining: Visualization of the tear film and detection of corneal damage
Schirmer test: Measurement of tear production volume
Lacrimal irrigation and probing: Assessment of the patency of the tear drainage channels
Dacryoscintigraphy or CT/MRI: Imaging to detect structural abnormalities in the lacrimal system

Treatment

Treatment is directed at the underlying cause of epiphora:

Conservative Management

Antiallergic eye drops or oral antihistamines for allergic causes
Antibiotic or antiviral eye drops for infectious causes
Discontinuation or substitution of causative medications
Artificial tears for reflex tearing due to dry eye syndrome

Surgical Treatment

Lacrimal probing and irrigation: For mild stenosis of the drainage channels
Balloon dacryoplasty: Dilation of narrowed tear ducts
Dacryocystorhinostomy (DCR): Surgical creation of a new drainage pathway into the nasal cavity for complete nasolacrimal duct obstruction
Eyelid surgery: Correction of ectropion or entropion when these are the cause

When to See a Doctor

Persistent tearing without an obvious cause, eye pain, reduced vision, or swelling near the inner corner of the eye should be evaluated by a medical professional. In newborns, whose nasolacrimal ducts are often not fully open at birth, an early ophthalmological assessment is recommended if symptoms persist beyond the first weeks of life.

References

Olver J, Cassidy L, Jutley G, Crawley L: Ophthalmology at a Glance. 2nd edition. Wiley-Blackwell, 2014.
Kanski JJ, Bowling B: Clinical Ophthalmology: A Systematic Approach. 8th edition. Elsevier, 2015.
American Academy of Ophthalmology (AAO): Tearing (Epiphora) – Preferred Practice Pattern. Available at: www.aao.org (accessed 2024).

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