A 50-year-old woman with a history of chronic blepharitis and dry eye complains of intermittent tearing, especially in windy conditions. There is no mucopurulent discharge, and lacrimal syringing is patent. Schirmer test is reduced. What is the mechanism of her epiphora?

• A Lacrimal pump failure due to orbicularis weakness
• B Mechanical obstruction of the nasolacrimal duct
• C Punctal stenosis
• D Hypersecretion due to reflex lacrimation from ocular surface irritation ✓

Explanation

In dry eye with reduced Schirmer test, epiphora occurs due to reflex hypersecretion from ocular surface irritation, not obstruction. The lacrimal drainage system is patent on syringing. Wind and cold stimulate reflex tearing via the trigeminal-vagal reflex arc. Mechanical obstruction would show regurgitation on syringing. Punctal stenosis would cause epiphora with a visible punctal abnormality. Lacrimal pump failure occurs in facial nerve palsy or ectropion.

Reference: Parsons' Diseases of the Eye, 23rd ed.

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Written and medically reviewed by the StethoPrep medical team.