We general ophthalmologists see a lot of dry eye patients who complain of tearing, but you’d be surprised how often it’s due to obstruction. Also, very often patients throw me a very skeptical look when I try to explain to them that their tearing is due to dryness. (We really have to start using the term Tear Dysfunction Syndrome…)

I therefore have gotten into the habit of quickly probing the canaliculus and irrigating, to see if there is egress into the nasopharynx. This accomplishes two things- it proves to the patient that indeed, their tear duct is not blocked (you’d be surprised how much that bit of information puts their minds at ease), and it reinforces the idea that dry eye, indeed, can cause tearing. (Also- great news!- you can bill for each canaliculus (use the E code for each lid, and be sure to add the -25 modifier to the eye exam and attach to a separate diagnosis. In just a couple of minutes, you added about $100!. For example:

92014-25….365.11 (glaucoma)

68840 E1, E2…375.20 (epiphora)