The etiological spectrum of epiphora: Functional epiphora as an overlooked cause

To investigate the etiologies of patients presenting with epiphora at a tertiary hospital ophthalmology clinic and the frequency of functional epiphora among these etiologies and to examine the diagnostic value of the combined use of lacrimal syringe and dacryoscintigraphy (DSG).

The patients who presented with symptomatic epiphora between January 2022 and December 2023 and who underwent ophthalmologic examination, lacrimal syringing, and DSG were retrospectively evaluated. The cause of epiphora was determined based on patient history, clinical examination, and test results.

This study included 247 eyes from 159 patients, consisting of 57 (36%) males and 102 (64%) females. The mean age of the patients was 54.9 ± 15.57 years (range, 19-88 years). The duration of symptoms was 47.1 ± 28.0 months (range, 3-120 months). The most common cause of epiphora was nasolacrimal duct (NLD) obstruction found in 76 (30.7%) cases. Functional epiphora, found in 56 eyes (22.6%), was the second most common cause of epiphora. Reflex tearing was the cause of epiphora in 45 eyes (18.2%). Other causes of epiphora included eyelid malposition (in 40 eyes, 16.1%), multifactorial epiphora (in 24 eyes, 9.7%), and pre-sac obstruction (in 6 eyes, 2.4%). Functional epiphora was more common in females and often unilateral.

Although NLD obstruction is the most common cause of epiphora, functional epiphora is a more frequent cause than previously anticipated. Observing complete patency in the lacrimal syringing is insufficient to rule out NLD stenosis and functional problems.