A review on functional epiphora- current understanding and existing lacunae

Abstract

ABSTRACTIntroduction: Epiphora in the presence of patent lacrimal system (functional epiphora) has remained one of the complex lacrimal problems. There is a lack of consensus regarding its diagnostic criteria and management options.Areas covered: The authors have extensively reviewed articles published on functional epiphora in terms of epidemiology, pathogenesis, clinical presentations, diagnostic modalities, treatment outcomes, and limitations.Expert opinion: Patients with functional epiphora have similar frequency and severity of epiphora as in primary acquired nasolacrimal duct obstruction with lesser incidence among children. Dacryoscintigraphy or dacryocystography fails to give conclusive results regarding the site of delay with high specificity. Endoscopic dacryocystorhinostomy (DCR) with intubation achieves the best outcomes followed by external DCR, and bicanalicular intubation alone in such cases. Differentiation into pre-sac and post-sac delay is necessary as pre-sac delay is associated with lesser success rate. Eyelid tightening surgeries alone do not provide good long-term results. Uniformity in terms of diagnostic tests of lacrimal drainage system, ocular surface evaluation, and differentiation of pre-sac from post-sac delay is needed to formulate the diagnostic criteria for functional epiphora.