This is called the tear pump. Paradoxically, it may also be due to an underlying dry eye problem which, in turn, causes a foreign body reaction and tearing. Likewise, it may be due to a lacrimal pump failure as in ectropion when tears are no longer able to enter the punctum. It may also be caused by punctum plugs or punctum cauterisation for the treatment of dry eye. Palpate the lacrimal sac to determine if it is enlarged due to dacryocystitis or a mucocele.
Pain suggests dacryocystitis.
A high marginal tear strip may indicate epiphora. If fluorescein is instilled in the conjunctival sac, it should disappear within two minutes - retention suggests there is a problem with lacrimal drainage. Their use may effect a cure by releasing mucous plugs or concretions. Dilation may produce temporary relief in a case of stenosis of the punctum. Lacrimal dilation is also used prior to inserting punctum plugs and syringing.