Epiphora is excessive tearing. It may be unilateral in which case there is usually obvious eye pathology, or it may be bilateral in which case it is psychogenic or related to the effects of drugs. The mnemonic MINT will help recall the most common causes.
· M—Malformation brings to mind ectropion or entropion especially in elderly patients.
· I—Inflammation suggests conjunctivitis, a corneal ulcer, or hordulum.
· N—Nervous system. This would bring to mind Bell palsy, migraine, and histamine cephalgia.
· T—Trauma should prompt the recall of a corneal abrasion or foreign body. Trauma may also have caused obstruction of the lacrimal ducts.
Approach to the Diagnosis
If the symptoms are bilateral, look for a history of drug use or emotional problems. If it is unilateral, careful examination of the eye before and after a drop of fluorescene is indicated. This may turn up a foreign body, corneal ulcer, or conjunctivitis. If this is unremarkable, referral to an ophthalmologist is in order.