Epiphora (excessive tearing) in the absence of periocular discharge points toward an obstruction at the upper lacrimal system — specifically at the punctum or canaliculus — rather than a downstream blockage. Recognising this pattern is the first step toward appropriate management.
The presence of epiphora without periocular discharge should raise the possibility of punctal or canalicular atresia. In some patients, the lacrimal puncta are blocked by a membrane covering the opening. In others, the canaliculi themselves are absent, with no visible punctal dimple on the eyelid.
Management depends on the specific anatomical abnormality identified. When a membrane occludes the punctal opening, treatment at the punctum level is often straightforward. When the canaliculi are absent, a more involved surgical approach is required — one whose timing may depend on which eyelid is affected and the patient's age.