Tearing on in downgaze - an important subgroup of tearing

*Jenny L. Lauschke^1,2, Geoff Wilcsek^1,2, Ian C. Francis^1,2

¹The Ocular Plastics Unit, Department of Ophthalmology, Prince of Wales Hospital, High Street, Randwick NSW 2031, Australia
²The University of New South Wales, Sydney NSW 2052, Australia

INTRODUCTION: Tearing in downgaze (TID) is a clinical entity that has not previously been reported. Lacrimal and ocular surface changes related to downgaze such as decreased blinking with reading, increasing ptosis, punctal apposition syndrome (PAS) and aggravation of conjunctivochalasis (CC), may suggest several of many possible underlying aetiologies of TID

METHOD: This prospective, consecutive study assessed 120 patients complaining of tearing. At their consultation, a tearing questionnaire was administered. They underwent a thorough lacrimal and eyelid examination by an Ocular Plastic surgeon in order to identify TID incidence, and severity amongst tearing patients, as well as contributing and aggravating factors.
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RESULTS: Ages ranged from 26 to 91 years with the usual female predominance. Of all study patients, 80% complained of some TID. 40% identified TID as the most bothersome component of their tearing.

Epiphora was present in 80% of cases and in half of these patients, epiphora was present more than 50% of the time. Pleolacrima was present in 50% of patients. Reading and driving were noted to be the activities most impacted on by TID. NLDO was identified as the single biggest aetiological factor for TID. Other factors included ocular surface disease, CC, lid laxity, entropion, ectropion and PAS. Most patients with TID suffered from several pathologies.

CONCLUSION: TID is a disabling condition which affects visual performance, particularly reading. A diagnosis of TID, along with a tailored clinical evaluation of the patient, may help establish the exact aetiology of the tearing, and improve its management.