Epiphora, or excessive tearing, is defined as the overflow of tears from one or both eyes. Epiphora can occur continuously (be present all the time), or it can occur intermittently (be present only sometimes). Epiphora is subdivided into two main categories: overproduction of tears or inadequate drainage of tears. In this article, we will be discussing inadequate drainage as a cause of epiphora.

Epiphora is a very common symptom and will become more common in an aging population. Many causes of epiphora are unrelated to anatomical problems in the nasolacrimal drainage apparatus. Problems in the upper lacrimal system have often been under-recognized as a cause of epiphora. In this review, we discuss the anatomy of the upper lacrimal system as well as the assessment of tear drainage in this system. Finally, specific causes of upper system epiphora and several new treatment modalities are discussed.