(From Epiphora 3588 to carry with a force )

In a medical sense, it is a violent determination, generally inflammatory, of the fluids to any part of the body; but more particularly the flow of tears from the eyes, in consequence of obstructed puncta lachrymalia, impervious nasal duct, or an inflammation of the eyes.

The epiphora, or watery eye, called rhocas, lippitudo, oculus lachrymans, and moon eye, is sometimes confounded with the fistula lachrymalis, for in both the tears run down the cheeks; but in the latter, pus is mixed with the tears. The obstruction in the puncta lachrymalia and nasal duct is sometimes owing to a tumour, as the encanthis in the great angle of the eye; to any accident, as a wound, or burn; to the destruction of the nasal duct; a polypus of the nose; a fistula lachrymalis; an inversion of the eye lid (see Entro-pium); an erosion or other defect of the carunculu lachrymalis.

Dr. Cullen places this disease in the class locales, and order apocenoses, and defines it a flux of the lachrymal humour. Only one species, the epiphora frigida, can, he thinks, be esteemed idiopathic; and of this there art-twelve varieties.

When the cause is a tumour in the angle of the eye, a polypus in the nose, a distortion in the eye lids, and a fistula lachrymalis, it must be removed. When from a conglutination of the puncta lachrymalia, we are to examine whether their ducts are totally obstructed or their mouths only covered; for if after a burn, or from a cicatrix after a wound, a cure is hardly to be expected : but if only a cuticle covers the duct, a perforation may be made with a needle; then a hog's bristle, or silver wire oiled, be passed through, and continued till the part is healed. If from a total want of the caruncula lachrymalis, a cure cannot be effected, because that gland cannot be restored. Mr. Ware thinks it may be occasioned either by a more copious secretion of tears than the puncta lachrymalia are capable of absorbing; or, which is more commonly the cause, by an obstruction in the lachrymal canal. It is the opinion of some anatomists, not only that part of the tears transude through the pores of the conjunctiva and cornea, but that their quantity is increased, and their acrimony abated, by the secretions of the caruncula lachrymalis, and the glandulae Meibomii. A morbid epiphora is consequently produced by an inflammation in the membranes of the eye, and to be cured by the remedies of inflammation. No such transudation, however, appears to take place. When it originates from an obstruction in the ducts, leading from the puncta lachrymalia into the lachrymal sac, which rarely occurs, the tears fall over the cheeks, and the sac is constantly empty. Pressure therefore on the sac can produce no regurgitation, cither of the tears or mucus, into the eye. A probe, of a suitable size, must in that case be introduced through the puncta of the obstructed ducts into the sac; and the operation repeated daily, till the obstruction is removed. The part in which the obstruction most commonly lies is in the sac itself; then the tears, on pressing the sac, mixed sometimes with mucus, flow back into the eye, through the puncture. The causes producing this obstruction to the passage of the tears, arc either a thickening of the membrane lining the sac, from previous inflammation: inspissated mucus lodged in the inferior portion of the cavity, from the same cause; or a spasmodic action of that part called the sphincter of the sac.-these three causes sometimes exist together, and mutually increase each other's effect.

Of the various remedies which have been proposed for the cure, Mr. Ware approves most of Monsieur Avel's, recommended first in the year 1712; which consisted in first passing a probe, and afterwards injecting a fluid through the puncta lachrymalia, in order to clear the matter which obstructed the lachrymal passage. Mr. Ware adopted this plan, which in several cases was attended with success. He had a small silver syringe, with pipes fitted to it of various sizes, much shorter than that represented in plate 37, vol. iii. of Bell's Surgery: they were a little arched towards the point, for the convenience of being introduced into the punctum lachrymale with more ease; of these he used the largest that could be introduced without pain, and through it he injected warm water. In introducing the pipe, he found it convenient to stand either behind the patient, or on the side opposite to that of the diseased eye, and always high enough to give him a full command of the patient's head. The syringe being held in the right hand, the eye lid was drawn downward, and a little outward, with the fore finger of the left hand. This brought the inferior punctum fully within the sight of the operator, and placed it in a position very convenient for admitting the point of the pipe. When the pipe was introduced, the finger was removed from the lower lid, and applied as accurately as possible over the superior punctum, to prevent the liquor from escaping through it; and with this finger the lachrymal sac was occasionally compressed, to assist the detennination of the liquor downwards to the nose. See Ware on the Epiphora, or Watery Eye; Heister's Surgery; White's Surgery, p. 233; and Dr. Wallis's Nosologia Oculorum.