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Epiphora is excessive tearing from one or both eyes. Epiphora is seen in children and adults. In a large epidemiological Scottish study, the prevalence of epiphora was found to be 20% in the first year of life.[1] The complaint of tearing from one or both eyes is a common presentation at an ophthalmic clinic. In our clinic, 13% of all new patients seen over two years (2017 to 2018) presented with epiphora. Because of involutional changes, tearing as a presentation becomes more common with age. Indeed, many patients will have some degree of tearing but will not complain about it. The two of the most common causes of tearing in adults are eyelid laxity and nasolacrimal duct obstruction. The incidence of nasolacrimal duct obstruction is 20.24 per 100,000.[2] The causes of epiphora, what history to obtain, and the clinical examination of patients who present with epiphora has been discussed in detail in our chapter entitled "epiphora." In this chapter, we discuss the tests that are performed when assessing patients with epiphora.

Trauma to the punctum, canaliculus, or lacrimal sac can create iatrogenic scarring when dilating or irrigating the lacrimal system. The following complications may be seen when dilating, probing, or irrigating children and adults: Punctal trauma can create stenosis. Forced probing can create a tear in the mucosa of the canaliculus with resultant scarring. Mucosal trauma to the lacrimal sac may occur if the probe is pushed forcefully or repeatedly. False passages into the sinus Precautions to avoid these complications: When dilating a punctum with a Nettleship dilator, always have the tip lubricated with an ointment. When inserting a punctal dilator, it is wise to twirl it as it is inserted. This way, it is less likely that a false passage will be created. Only use the Nettleship dilator to dilate the vertical section of the canaliculus. Do not turn the punctal dilator to probe the canaliculus. Use an OO Bowman probe when probing. It should also be lubricated with ointment. Do not apply force to a canalicular scar as it is likely to create a false passage and further canalicular scarring. Always ensure that a "hard stop" in the lacrimal sac is felt before turning the Bowman probe into the nasolacrimal duct. When carrying out serial dilatations of the nasolacrimal duct, increase the probe thickness gradually (sequentially)