Epiphora Caused by Upper Lacrimal Drainage System Problems

Byoung Jin Kim, Md; Angelo Tsirbas, Md, Franzco

In This Article

Abstract and Introduction

Epiphora is a very common symptom and will become more common in an aging population. Many causes of epiphora are unrelated to anatomical problems in the nasolacrimal drainage apparatus. Problems in the upper lacrimal system have often been under-recognized as a cause of epiphora. In this review, we discuss the anatomy of the upper lacrimal system as well as the assessment of tear drainage in this system. Finally, specific causes of upper system epiphora and several new treatment modalities are discussed. (Comp Ophthalmol Update 6: 231-6, 2005)

The causes of epiphora are varied in nature, and much attention has been focused on various pathological processes that can lead to problematic watering. The upper lacrimal system is an area that has often been overlooked as a cause of problems. In this review, we will discuss the anatomy and pathophysiology of the upper tear drainage; we will also look at common problems that lead to epiphora. In addition, we will discuss newer treatments for upper lacrimal system pathology.

An appreciation of the balance between the production and the drainage of tears is important to understand how various processes may disturb this pattern. The balance between the production and the drainage of the tear film is critical to clear, symptom-free vision.

The tear film is a complex biolayer that is made up of various components. When dealing with epiphora, it is often helpful to consider secretion and excretion of the tears.