title: Management and outcomes of patients with epiphora referred to a specialist ophthalmic plastic unit.
abstract: BACKGROUND
  To describe the aetiology and management of the symptom epiphora presenting to a specialist ophthalmic service.
  
  
  METHODS
  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.
  
  
  METHODS
  Two hundred thirty-seven patients were identified, of which 192 met the inclusion criteria. Fifty-seven were male, 135 were female, with a mean age of 60.7 (range 0-95) years.
  
  
  METHODS
  Patients were identified using a key word search of clinic letters and a search of primary care coding.
  
  
  METHODS
  Duration of symptoms, referral source, aetiology and subjective improvement of symptoms post treatment.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  This study highlights the protean aetiology of the symptom and sign, epiphora. Sparse data exist 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.
authors.affiliation: Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sibley
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Norris
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005141:Eyelid Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008537:Meibomian Glands / Q000473:pathology; D008875:Middle Aged; D009885:Ophthalmology; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D013038:Specialization; D011795:Surveys and Questionnaires; D013666:Tears / Q000737:chemistry; D000078329:Workforce; D055815:Young Adult