A review on functional epiphora- current understanding and existing lacunae

ABSTRACT

Introduction: Epiphora in the presence of patent lacrimal system (functional epiphora) has remained one of the complex lacrimal problems. There is a lack of consensus regarding its diagnostic criteria and management options.

Areas covered: The authors have extensively reviewed articles published on functional epiphora in terms of epidemiology, pathogenesis, clinical presentations, diagnostic modalities, treatment outcomes, and limitations.

Expert opinion: Patients with functional epiphora have similar frequency and severity of epiphora as in primary acquired nasolacrimal duct obstruction with lesser incidence among children. Dacryoscintigraphy or dacryocystography fails to give conclusive results regarding the site of delay with high specificity. Endoscopic dacryocystorhinostomy (DCR) with intubation achieves the best outcomes followed by external DCR, and bicanalicular intubation alone in such cases. Differentiation into pre-sac and post-sac delay is necessary as pre-sac delay is associated with lesser success rate. Eyelid tightening surgeries alone do not provide good long-term results. Uniformity in terms of diagnostic tests of lacrimal drainage system, ocular surface evaluation, and differentiation of pre-sac from post-sac delay is needed to formulate the diagnostic criteria for functional epiphora.

KEYWORDS:

• Functional epiphora
• dacryocystorhinostomy
• endoscopic
• lacrimal pump
• dacryoscintigraphy

Article highlights

• Functional epiphora seems to be multifactorial with numerous terminologies, and lacks a definite diagnostic criterion. Inclusion of partial NLDO under functional epiphora adds to the confusion.

• This condition is currently less understood and differentiation of reflex hypersecretion owing to an unstable ocular surface from stenosis or lacrimal pump failure needs to be performed.

• Investigative modalities with physiological evaluation can differentiate between pre-sac versus post-sac delay, and reflex epiphora versus true functional epiphora.

• Management options depend upon the suspected etiology, and endoscopic DCR with intubation has shown the best outcomes followed by external DCR, and bicanalicular intubation alone in such cases.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.