What is epiphora?
Epiphora means an overflow of tears from the eyes. It is a symptom rather than a specific disease and is associated with a variety of conditions. Normally, a thin film of tears is produced to lubricate the eyes and the excess fluid drains into the tear ducts (nasolacrimal ducts), which are located in the corner of the eye next to the nose. The tear ducts drain tears into the back of the sinuses and down the throat. Epiphora can be caused by either insufficient drainage of tears through the tear ducts, or by an excessive production of tears.
What are the signs of epiphora?
Common clinical signs associated with epiphora are dampness or wetness beneath the eyes, reddish-brown staining of the fur beneath the eyes, odor, skin irritation, and skin infection. Many owners report their cat's face is constantly damp, and they may even see tears rolling off their pet's face.
How is epiphora diagnosed?
The first step is to determine if there is an underlying cause triggering excess tear production. A thorough eye examination is performed, paying special attention to the tear ducts and nearby tissues, and looking for signs of inflammation or other abnormalities. Additional tests may be done to measure the tear production (called a Schirmer tear test), look for corneal ulcers, or measure the pressures inside the eyes.
"The first step is to determine if there is an underlying cause triggering excess tear production."
Causes of increased tear production in cats include: conjunctivitis (viral or bacterial), allergies, eye injuries, abnormal eyelashes (distichia or ectopic cilia), corneal ulcers, eye infections, anatomical abnormalities such as rolled in eyelids (entropion) or rolled out eyelids (ectropion), and glaucoma (high pressures inside the eye).
Once more serious causes of epiphora have been eliminated, it is necessary to determine if proper and adequate tear drainage is occurring. Facial anatomy of a cat may play a role in this condition. Some breeds (e.g., Persians and Himalayans) have flat or squished-in faces (brachycephalics) that do not allow tears to drain properly. In these pets, the tear film fails to enter the duct and simply rolls off the face. In other cases, hair around the eyes may physically obstruct the entrance to the nasolacrimal ducts, or debris or a foreign body may form a plug within the duct and prevent drainage of tears.
"Facial anatomy of a cat may play a role in this condition."
Your veterinarian may assess tear drainage by placing a drop of fluorescent dye (fluorescein stain) into the eye and watching for drainage out of the nostril. If the drainage system is functioning normally, the eye stain should be seen in the nose within a few minutes. Failure to observe the stain does not definitively diagnose a blocked nasolacrimal duct, but it does indicate the need for further investigation.
How is epiphora treated?
If the nasolacrimal duct is suspected of being blocked, your cat will be anesthetized, and a special instrument will be inserted into the duct to flush out the contents. In some cases, the opening to the duct (called the nasolacrimal puncta) may have failed to open during your cat's development. If that is the case, it can be surgically opened during this procedure. If chronic infections or allergies have caused the ducts to become narrowed, flushing may help widen them. This procedure may need to be done by a veterinary ophthalmologist (eye specialist).
If the cause is related to another eye condition, treatment will be directed at the primary cause and may include surgery.
What can I do for the staining?
Many remedies have been recommended for removing or eliminating facial staining associated with excess tears, but none have been proven 100% effective. Low doses of some antibiotics are no longer recommended due to the risk of developing bacterial antibiotic resistance, rendering these valuable antibiotics worthless for human and veterinary use.
Short courses of appropriately dosed antibiotics can be reserved for severe cases if there is a secondary skin infection (redness, odor, or discharge). Some over-the-counter products have been suggested but have not been proven to be effective in research trials, and some may be harmful or injurious to the eyes.
Keeping the area as clean and dry as possible, removing any build-up, and trimming the fur around the eyes short can help. There is some evidence that daily probiotics can be helpful, but it can take months to see improvement. Do not use any product without consulting with your veterinarian. Avoid using any product that contains hydrogen peroxide near the eyes. These products can cause severe damage if inadvertently splashed into the eyes.
What is the prognosis for epiphora?
Unless an underlying cause can be found and treated, most patients with epiphora will experience intermittent episodes throughout their life. If your cat's facial anatomy prevents adequate drainage of the tear film, it is likely that some degree of epiphora will persist despite all treatment efforts. In many cases, no significant problems may arise, and the tear staining may be cosmetic. Your veterinarian will discuss the particulars of your cat's condition and will determine the specific treatment options and prognosis for your cat.
