Management of Persistent Epiphora After Lacrimal Drainage Surgery

Patients with persistent epiphora following lacrimal surgery need a thorough investigation to assess possible causes, as post-operative tearing may be due to failed lacrimal surgery, but also to unrecognized and untreated meibomian gland dysfunction, conjunctivochalasis, eyelid laxity, to a distorted lower punctum, or weakened orbicularis muscle. Non-lacrimal causes of functional epiphora should be identified and adequately treated. Dacryocystectomy has limited indications, but patients need adequate information and counseling as they will experience persistent post-operative epiphora. Redo surgery techniques through endoscopic endonasal and external approaches are discussed. The injection of botulinum neurotoxin A to the lacrimal gland can be an alternative to manage persistent post-operative epiphora.