Epiphora, overflowing of tears, is not uncommon when there is sympathetic or reflexive tearing, because the lacrimal glands are producing larger than normal quantities of aqueous tears.

Some people experience epiphora after they receive punctal plugs or punctal cautery, because, even though they may not be producing normal amounts of aqueous tears, the normal channel of tear flow is blocked. In these cases, as long as there is no other situation which would indicate that it is prudent to retain tears, it may be best to allow some tears to flow out by removing punctal plugs, or reversing punctal cautery, at least partially.

Incomplete blinks can cause epiphora. If there is partial cautery, an incomplete blink does not create enough suction for the tear film to flow out through the tear ducts, and the tears are retained in the eye. If too many tears are retained, eventually there is epiphora.

Even the smallest amount of epiphora can be very uncomfortable, because tears flow out of the eyes and onto the delicate and sensitive skin of the lid margin, lids, and around the eyes.