Unusual causes of epiphora.

Case IX, a 54-year-old female, presented with a history of unilateral epiphora of 7 years' duration. There was no history of injury or of inflammation and the exact date of onset could not be determined. There was, however, a long history of chronic irritation for which drops of various kinds had been instilled over a period of many years. She had been seen previously when, after lacrimal syringing, she was advised that there was no lacrimal pathology; drops were prescribed. On examination the lacrimal system appeared to be normal; this was confirmed by dacryocystography. Slit-lamp examination, however, revealed the cause of the epiphora. A granuloma, attached by a pedicle to the posterior surface of the lower lid, was occluding the punctum, like a cork in a bottle (Fig. i). This granuloma was supplied by a blood vessel traversing its pedicle and when withdrawn from the punctum was found to have a conical shape as a result of moulding within the punctum. When in position, it caused epiphora by occluding the punctum, but it could be displaced quite easily by a lacrimal cannula, which entered the canaliculus without difficulty.