Investigation and treatment of epiphora due to lid laxity.

Many patients with lid laxity, in spite of reasonable punctal and lid-globe apposition, may have tearing because of a "lacrimal pump" dysfunction. Dacryocystography and nuclear lacrimal scanning aid when the diagnosis is not obvious clinically. The punctal stenosis, which is almost always secondary to punctal eversion, is treated by dilatation and a punctal inversion procedure. The lax lids are treated with a modified Bick procedure, and in cases of co-existent medial lid laxity, a medial canthoplasty is performed.