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The BLICK Mnemonic for Clinical–Anatomical Assessment of Patients With Epiphora

Tse, David T. M.D.; Erickson, Benjamin P. M.D.; Tse, Brian C. M.D.

Ophthalmic Plastic and Reconstructive Surgery: November/December 2014 - Volume 30 - Issue 6 - p 450–458
doi: 10.1097/IOP.0000000000000281
Major Review

Purpose: Evaluation of the tearing patient is often distilled to a search for ocular surface problems causing reflex hypersecretion versus lacrimal drainage problems. The literature does not typically emphasize conditions affecting the function of the tear distribution system, but neglect of these important factors can lead to suboptimal treatment outcomes. The intent of this review is to provide a systemic evaluation of frequently overlooked conditions that can influence the distribution system and to offer a mnemonic to ensure an orderly sequence of inspection during clinical examination.

Methods: Review of clinical literature and experience from 1957 to 2014.

Results: Tearing complaints attributable to problems with the distribution system can be evaluated, classified, and managed according to the mnemonic BLICK, which stands for Blink dynamics, Lid malposition, Imbrication, Conjunctivochalasis, and Kissing puncta.

Conclusion: The BLICK mnemonic is a useful adjunct to the workup of epiphora.

Conditions affecting the tear distribution system may be overlooked in the workup of symptomatic epiphora; we offer a review and mnemonic to guide clinical examination.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.

Accepted for publication July 9, 2014.

Supported in part by National Institutes of Health Center Core Grant P30EY014801; Research to Prevent Blindness Unrestricted Grant, Inc., New York, NY, U.S.A.; Plum Foundation, Los Angeles, CA, U.S.A. and the Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Fund. The sponsor or funding organization had no role in the design or conduct of this research.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to David T. Tse, M.D., Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 N.W. 17th Street, Miami, FL 33136. E-mail:

© 2014 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.