Epiphora (medical)
Encyclopedia
Epiphora is overflow of tears onto the face. A clinical sign or condition that constitutes insufficient tear film
Tears
Tears are secretions that clean and lubricate the eyes. Lacrimation or lachrymation is the production or shedding of tears....

 drainage from the eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...

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

Etiology

Causes of epiphora include occular irritation and inflammation (including trichiasis
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 trauma such as burns or eyelid injury.Standard treatment...

 and entropion
Entropion
Entropion is a medical condition in which the eyelid folds inward. It is very uncomfortable, as the eyelashes constantly rub against the cornea. Entropion is usually caused by genetic factors and may be congenital...

) or an obstructed tear outflow tract which is divided according to its anatomical location (ie. ectropion, punctal, canalicular or nasolacrimal duct obstruction). The latter is often due to aging (a spontaneous process), conjunctivochalasis
Conjunctivochalasis
Conjunctivochalasis 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 eye-lid margin.-Symptoms and Diagnosis:...

, infection (ie. dacryocystitis
Dacryocystitis
Dacryocystitis is an infection of the nasolacrimal sac, frequently caused by nasolacrimal duct obstruction. The term derives from the Greek dákryon , cyst , and -itis . It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora...

), rhinitis
Rhinitis
Rhinitis , commonly known as a stuffy nose, is the medical term describing irritation and inflammation of some internal areas of the nose. The primary symptom of rhinitis is nasal dripping. It is caused by chronic or acute inflammation of the mucous membrane of the nose due to viruses, bacteria or...

, 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.

Diagnosis

Diagnosis of epiphora is clinical by history presentation and observation of the lids. Fluorescein
Fluorescein
Fluorescein is a synthetic organic compound available as a dark orange/red powder soluble in water and alcohol. It is widely used as a fluorescent tracer for many applications....

 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.

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
Dacryocystorhinostomy is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.-Traditional:...

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