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Etiology of Tearing: A Retrospective Analysis of Referrals to a Tertiary Care Oculoplastics Practice

Mainville, Norman M.D.; Jordan, David R. M.D.

Ophthalmic Plastic & Reconstructive Surgery: May-June 2011 - Volume 27 - Issue 3 - p 155-157
doi: 10.1097/IOP.0b013e3181ef728d
Original Investigations

Purpose: To determine the etiology of tearing among referrals to a tertiary care ophthalmology practice specializing in oculoplastics.

Methods: A retrospective chart review was conducted of 150 consecutive referrals to our practice for tearing. The main diagnosis was noted in all cases as well as treatment offered and response to therapy. An anatomical approach was used to classify the tearing etiology. The categories included the following: dry eye with reflex tearing, tear hypersecretion, ocular surface disease (e.g., pterygium, pinguecula), lid abnormalities (e.g., entropion, ectropion), upper lacrimal system (e.g., punctal stenosis, canalicular block), and lower lacrimal system (e.g., dacryocystitis, dacryostenosis, nasolacrimal duct obstruction).

Results: Review of the charts of 150 consecutive pts referred for tearing revealed that although the most common etiology was obstruction of the nasolacrimal system, dry eye with reflex tearing was almost as common. Specifically, 48.7% (n = 73) had a blockage of the lacrimal system (8% [n = 12] upper system, 40.7 [n = 61] lower system), 40% (n = 60) were felt to have dry eye with reflex tearing, 6.7% (n = 10 patients) had a lid abnormality, 1.3% (n = 2 patients) had lacrimal hypersecretion, 0.7% (n = 1 patient) had ocular surface disease, and 2.7% (n = 4 patients) had a normal lacrimal system on exam.

Conclusions: Our retrospective review of a series of patients referred to our practice for tearing revealed a significant proportion of patients whose tearing etiology was other than a nasolacrimal duct obstruction. Of particular interest is the fact that 40% of patients had dry eye with reflex tearing, and the majority of these improved with lubrication. These patients were all identified by performing a Schirmer test to quantify the basal tear production. We believe that the Schirmer test is a useful diagnostic tool in assessing patients with tearing and ensuring that the appropriate management approach is undertaken.

Of 150 consecutive referrals for tearing, dry eye with reflex tearing was identified as a cause in 40% with the aid of a Schirmer basal secretion test (Schirmer I).

Department of Ophthalmology, University of Ottawa Eye Institute and The Ottawa Hospital, Ottawa, Ontario, Canada

Accepted for publication June 21, 2010.

The authors have no proprietary interest in any aspect of this study.

The authors had no financial support for this study.

Address correspondence and reprint requests to Dr. David R. Jordan, M.D., 301 O'Connor St, Ottawa, Ontario, Canada, K2P 1V3. E-mail:

©2011The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.