Epiphora

P R E S E N T E R : S U R E N D R A P R A S A D S A H
M . O P T O M ( 2 N D S E M )
( 1 6 / 0 3 / 2 0 1 5 )
Epiphora
1
Epiphora ,s.sah 3/16/2015

 Epiphora implies to overflowing of tears due to impairment
lacrimal drainage.
 OR
 due to a disruption in the balance between tear production
and tear loss.
2

Causes
3

Anatomical  complete or partial punctal
canalicular or NLD obstruction
Functional  Lacrimal pump failure due to
Anatomical deformity (Laxity, orbicularis
weakness)
4

Eyelids
 Horizontal laxity and floppy lids
 Lower lid entropion with orb.oculi overriding
 Lower lid ectropion with ineffective orb.oculi
 Loss of skin / orbicularis
7

Punctal Causes
 Occlusion
 Infection/radiation
 Systemic: phemphigoid,SJS,Burns
 Tumours
 Medial displacement
 Medial ectropion
8

Canaliculi
Congenital absence/fistula
 Acquired
Intrinsic
 Canaliculitis
 Trauma/ Post radiation Trauma/ Post radiation
 Tumours
Extrinsic
 Compression by adjacent tumours
9

Lacrimal Sac Abnormality
Sac inflammation
Perilacrimal fibrosis
Dacryolithiasis
 Sac tumours (rare in pediatric age group)
 Adnexal tumours pressing on lacrimal sac or drainage
pathway
10

Nasolacrimal duct
Congenital:
 NLD obstruction
 Delayed opening of Hasner’s valve,
 Cranio facial anomalies
 Agenesis.
Acquired:
 Primary obstruction
 Secondary obstruction: tumour, trauma
NASAL CONDITIONS
 Severe Deviated Nasal Septum or Turbinate Hypertrophy
11

Excessive tears production
Reflex lacrimation in response to various factors
Trichiatic cilia
Severe entropion
Raised IOP
 Allergic conjunctivitis
Corneal exposure
 Drugs irritation
 Environmental irritants likes pollution
12

Others
 Ocular surface disorders like chronic KCS,
conjunctivochalasis, cicatricial ocular surface pemphigoid,
symblephron.
 Neurogenic hypersecretory disorders like compressive
irritation of parasympathetic lacrimal fibres, Aberrant
regeneration of facial nerve following trauma.
 Facial palsy
13

Evaluation
14

Evaluation
 Careful history
 External examination
 Slit lamp biomicroscopy
 Syringing and probing
 Imaging
15

DIAGNOSTIC TESTS
16

Anatomical tests
These tests helps in localization of obstruction
 Syringing / irrigation
 Diagnostic probing
 Dacryocystography
 CT/MRI
17

Functional tests
To access functioning of lacrimal apparatus under
physiologic conditions
Performed only when there is no evidence of
obstruction in anatomical tests
 Flourescein dye disappearance test
 Jones dye test (jones primary and secondary )
18

Imaging technique
Contrast Dacryocystography
Lacrimal dacryocystography
CT/MRI
19

Managements
20

Eyelids
 Treatment of the cause
 Ectropion surgery.
 Tarsorraphy
21

Punctal Causes
Dilation of punctum
Punctoplasty
Ziegler cautery
Medial conjunctivoplasty
Lower lid tightening
22

Canaliculi
Depends on the site and degree of obstruction
Intubation
Anastomosis of the patent part of the canaliculus
into the lacrimal sac and intubation
23

Nasolacrimal duct
Massage of the lacrimal sac increases the hydrostatic
pressure and may rupture membranous obstruction
Probing of the lacrimal system
24

Lacrimal surgery
Dacryocystorhinostomy (DCR)
 Indicated for obstruction beyond the medial opening of the
common canaliculus
 Anastomosing the lacrimal sac to the nasal mucosa of the
middle nasal meatus
 Procedure is performd under general hypotensive
anaesthesia
25

Excessive tears production
Epilation
Entropion lid surgery
Deceased IOP
Treatment of conjunctivitis
Sunglass
26

Conclusion
 Diagnosis of the condition and ruling out the cause is
important.
 Treatment of the cause will depend on the cause of
watering.
 Optometrist should treat the causes to anterior
segment disease.
 Cases requiring surgery should be referred to
ophthalmologist.
 Cases of systemic disease should be referred to
physician.
27

References
3/16/2015Epiphora ,s.sah
28
Books
Thimothy L. Jackson Moorfields manual of
ophthalmology ,1:212-228
Mark W Leitman Manual for eye examination
and diagnosis.7th ed.
Ak khurana Comprehensive Ophthalmology
5th ed, 1 :271 :302
Kanski J Jack Clinical ophthalmology a
systematic approach 2011,7th ed,1: 151-172

Question
3/16/2015Epiphora ,s.sah
29
 How can you evaluate patient having Epiphora
 How can you treat pediatric patient having epiphora
 What are causes punctum

Epiphora

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Epiphora