Look for mucoid discharge, perform dye disappearance test when addressing epiphora
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WAILEA, Hawaii — Distinguishing between watery eyes and tearing eyes in patients is important for identifying destruction to the lacrimal system, according to a speaker here.
Watery eyes do not always indicate a blocked tear duct and can sometimes be a sign of a tear film abnormality or blinking issue, Femida Kherani, MD, FRCSC, said a presentation at Hawaiian Eye 2024.
“My number one question and pearl for you is to ask the question: Does the tear run down the cheek?” she said. “[If it does], that’s frank epiphora, and destruction of the lacrimal system is characterized by frank epiphora.”
Lacrimal pump function is another important consideration, Kherani explained.
“I find that many of my patients actually have pump problems, even though they complain about wet eyes,” she said.
A poor lacrimal pump can be caused by weak or loose eyelids. Ophthalmologists should look for inadequate draininage caused by canalicular obstruction and nasolacrimal duct obstruction, Kherani said.
In addition, other indicators for true epiphora include patient history with dacryocystitis, presence of acute infections and mucoid discharge.
“You may feel, when you press on the lacrimal sac, that there might be mucoid discharge,” Kherani said. “So, [if there is] presence of mucoid, you know there is an obstruction. And this is often common after conjunctivitis, facial fracture and nasal surgery.”
A dye disappearance test can be also be useful when searching for signs of lacrimal system dysfunction.
“I put in the dye, and I check to see: Does it go away or is it actually streaming? That shows me where the problem is,” she said. “Is it a lateral laxity or a medial obstruction?”
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Kherani F. Who’s crying now? Causes and fixes for tearing. Presented at: Hawaiian Eye 2024; Jan. 13-19, 2024; Wailea, Hawaii.
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