Patterns and causes of epiphora referrals to a tertiary oculoplastic practice.

[OBJECTIVE] To report the causative factors and surgical candidacy of patients referred to an oculoplastic surgery clinic for the complaint of epiphora.

[DESIGN] Prospective observational study.

[PARTICIPANTS] Consecutive patients (n = 159) referred to a tertiary care oculoplastic surgery clinic over a 12-month period for the complaint of epiphora.

[METHODS] The causative factor most responsible for tearing was determined based on clinical examination by the principal investigator, who was blinded to referral source. Patients were considered surgical candidates with a diagnosis of significant nasolacrimal duct obstruction, lid malposition, or pump dysfunction. The primary outcome was the percentage of referrals that were surgical candidates, classified by referral source.

[RESULTS] The most common cause of tearing was nasolacrimal duct obstruction, occurring in 53 of 159 (33%) patients. The percentage of surgical candidates was highest in referrals from ophthalmologists (82%), followed by optometrists (67%) and family physicians (55%; p = 0.011 for difference between ophthalmologists and family physicians).

[CONCLUSIONS] Epiphora may be because of a variety of causes, some of which are amendable to surgical treatment. In the absence of an obvious cause, a trial of lubrication by the family physician is warranted before referral being made to an oculoplastic surgeon.