A 42-year-old man presents with tearing. What could be the cause?
Analysis
Terminology to be aware of when managing the tearing patient include epiphora, syringing, dacryocystogram (DCG), and dacryoscintigram (DSI).
Epiphora describes the overflow of tears onto the cheek. Syringing is a procedure which assesses patency of the punctum; it is often incorrectly termed as flushing or irrigation. DCG and DSI are both types of radiographic imaging. DCG characterizes the anatomy whereas DSI characterizes the physiology of the lacrimal apparatus.
Patients with positive DSI tend to have good outcomes with endonasal dacryocystorhinostomy (DCR), which is the surgical procedure pictured, to reduce fluid retention in the lacrimal sac.
In this 17-minute video featuring Dr. Ahsen Hussain, assistant professor at Dalhousie University in Nova Scotia, you will:
- Review the causes of tearing
- Learn how to take a thorough history for the tearing patient
- Review the management for tearing
Plastics Coach Tip
The most common causes of tearing include reflex tearing due to dry eye, involutional changes such as eyelid or punctal malposition and weakening of the lacrimal pump, and pathology of the drainage system such as canalicular or nasolacrimal duct obstruction.
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