The Dry Eye Zone

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Abstract: Why are my eyes always watering?

To describe the aetiology and management of the symptom epiphora presenting to a specialist ophthalmic service.
A retrospective case series and patient postal questionnaire of all new referrals seen in a specialist unit with primary symptoms of epiphora between January 2007 and December 2008. The study was begun in 2010 to allow a 2-year follow-up for this cohort.
237 patients were identified, of which 192 met the inclusion criteria. There were 57 male, 135 female, with a mean age of 60.7 (range 0-95) years.
Patients were identified using a key word search of clinic letters and a search of primary care coding.
Duration of symptoms, referral source, aetiology and subjective improvement of symptoms post treatment.
At consultation, patients had experienced epiphora for a mean of 41.1 (range 0.066-360) months. A diagnosis of partial or complete nasolacrimal duct obstruction (31.8%), dry eye with secondary reflex tearing (29.2%), eyelid malposition (10.4%) and multi-factorial epiphora (28.7%) was made after follow up and treatment. A postal questionnaire follow up showed that 25% of patients no longer had any epiphora, with 67% reporting an improvement in their symptoms. Final follow-up was 30-54 months.
This study highlights the protean aetiology of the symptom and sign, epiphora. Sparse data exists on the audited success in managing this common symptom and sign. This study helps introduce an example of a benchmark for evaluating the effectiveness of epiphora. The majority of patients were referred, usually by ophthalmologists for lacrimal surgery.

Clin Experiment Ophthalmol. 2012 Sep 7. doi: 10.1111/j.1442-9071.2012.02866.x.
Sibley D, Norris JH, Malhotra R.
Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK.