Epiphora: A Structured Diagnostic Approach for the Otolaryngologist

Epiphora, or excessive tearing, has historically been predominantly managed by ophthalmologists. However, as there is substantial overlap between ophthalmic and otolaryngologic anatomy and pathology that may contribute to epiphora, patients with this symptom often present to otolaryngologists as well. Similarly, the differential of underlying etiologies for epiphora extends well beyond nasolacrimal duct obstruction, encompassing a wide array of conditions, each of which may be managed primarily by one or the other field. Judicious clinical evaluation of epiphora in each case is thus essential to identify the etiology accurately and to guide management appropriately.

This narrative review summarizes the common etiologies of epiphora and outlines a structured clinical approach to its evaluation. PubMed/MEDLINE and Embase were searched (inception to May 2025) for English literature on epiphora and its etiologies to inform this paper.

We present concise descriptions of key clinical features and corresponding diagnoses, supplemented with clinical and radiographic photographs. In addition, we describe a structured approach to the evaluation of patients presenting with epiphora.

The management of patients with epiphora is an evolving area at the intersection of otolaryngology and ophthalmology. This review provides otolaryngologists with a primer on common etiologies underlying epiphora and offers a structured framework for evaluation of this impactful symptom.