From the lacrimal patient

• Duration of symptoms

• Unilateral or bilateral

• Constant or intermittent

• Precipitating factors (for example, cold or windy weather)

• Spillover of tears at medial or lateral canthus

• Associated symptoms (for example, discharge, blurred vision, skin excoriation)

• Past history: cicatricial skin or ocular diseases, herpetic disease, eyelid trauma, dacryocystitis

• Chronic nasal disease, nasal injury and surgery to the nose or sinuses

• Drug history: including topical medications, anticoagulants, antiplatelet drugs

• Fitness for surgery

Figure 10.11 Lateral canthal spillover of dye in a patient with lower lid laxity as the main cause for epiphora.

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