True epiphora vs. pseudoepithelialization, mechanism, diagnostic methods, treatment direction

👁 Tearing vs Overflow – Understanding True vs Pseudo-Epiphora

“Tearing” is one of the top 3 most common complaints in ophthalmology.
But not all tearing is the same — understanding whether the tears overflow or not is crucial to diagnosis and treatment.

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✅ Key Definitions

TermMeaning

Tearing	Accumulation of tears in the eye
Overflow	Tears running down the cheek
True Epiphora	Caused by blocked tear drainage
Pseudo-Epiphora	Caused by excessive tear production

 

 

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✅ True Epiphora

• Due to blocked lacrimal drainage system
• Overflow occurs because tears can’t exit properly
• System includes: Punctum → Canaliculus → Lacrimal sac → Nasolacrimal duct

🔍 Upper vs Lower Drainage Obstruction

TypeClues

Upper (punctum, canaliculus)	Overflow only
Lower (sac, nasolacrimal duct)	Overflow + sticky discharge

• Upper: Office-based procedures
• Lower: Requires surgical intervention (e.g., DCR)

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✅ Pseudo-Epiphora

• Tear production increases without drainage issues
• Overflow usually does not occur

🔍 Causes

1. Ocular surface irritation
   • Dry eye, blepharitis, conjunctivochalasis
2. Crocodile Tear Syndrome
   • Misguided facial nerve regeneration
   • Tears induced by chewing/thinking about food
3. Intracranial causes (rare)
   • Tumors or aneurysms pressing on tear pathways

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✅ Treatment

• No surgery required
• Address underlying issues like dry eye or inflammation
• Manage neural causes when identified