RESUMEN
PURPOSE: To describe the causes of congenital epiphora in patients with Down syndrome. METHODS: Retrospective study of 695 patients with congenital epiphora, of the Lacrimal Sector of the Department of Ophthalmology, São Paulo "Santa Casa", Brazil, between October 1998 and July 2005. This study analyzed: the main symptom of continuous epiphora or mucous discharge, which affected one or both eyes, since birth. Subjects were separated in to two groups: group A, with 30 patients with Down syndrome and group B, with 665 control patients. The lacrimal evaluation was performed by the throw irrigation test after general anesthesia. RESULTS: Both groups were statistically similar regarding age (p=0.07), sex (p=0.63) and race (p=0.68). Bilateral symptoms were more frequent in group A (p=0.0008). Anatomic obstruction of the lacrimal canal was present in 32.73% of group A and in 85.51% of group B (p<0.0001). CONCLUSIONS: The most frequent cause of congenital epiphora in Down syndrome is due to functional block of the lacrimal pump. Eyelid muscle hypotony and eyelid changes, common in Down syndrome, is the main hypothesis of lacrimal dysfunction, but further studies will be necessary for confirmation.