hyperlacrimation

Hyperlacrimation, also known as epiphora, is the condition of excessive tearing from the eye. It occurs when the tear film is produced in excess or cannot drain normally, leading to tear overflow onto the cheek. The result may be a persistent tearing sensation, blurred vision from a watery surface, and irritation from continuous moisture.

Most cases of hyperlacrimation arise from impaired tear drainage, such as nasolacrimal duct obstruction or punctal stenosis. Other common causes include reflex tearing from ocular surface irritation (dry eye, conjunctivitis, allergies, foreign bodies, contact lens problems, blepharitis), eyelid malpositions (ectropion or entropion), or conditions affecting lacrimal control. Gustatory tearing (tearing triggered by eating) and emotional tearing can contribute in some individuals.

Evaluation typically begins with a detailed history and a thorough eye examination, focusing on eyelids, puncta, and the tear film. Diagnostic tests may include fluorescein dye disappearance testing, Schirmer test to assess tear production, and irrigation or syringing to evaluate tear drainage. Imaging or specialized lacrimal studies (such as dacryocystography) may be used when obstruction is suspected.

Management depends on the underlying cause. For ocular surface disease or irritation, treatment aims to reduce irritation and stabilize the tear film, using lubricating drops, anti-inflammatory therapies if indicated, lid hygiene, and management of allergies. If drainage is impaired, approaches range from punctal dilation, blockage with punctual plugs, or canalicular procedures to bypass obstruction. Nasolacrimal duct obstruction may require dacryocystorhinostomy or other reconstructive procedures. Eyelid malpositions are addressed surgically. In some mild or transient cases, observation is appropriate. Referral to an ophthalmologist is advised for persistent or unclear causes.