Dear Editor,

We read with great interest the article by Sipkova et al. [1] entitled “Assessment of patient-reported outcome and quality of life improvement following surgery for epiphora” in the December 2017 issue of Eye. We have reviewed the patient-reported outcomes of our own patients who have undergone surgery for epiphora. We would like to share our experience with readers.

Sipkova et al. [1] discussed the relevant limitations of the Glasgow Benefit Inventory (GBI), Munk symptoms score [2], and Lac-Q questionnaire. In our study, we prospectively enrolled 17 patients (20 eyes) who underwent lateral tarsal strip procedures for epiphora and lower lid laxity between June 2014 and September 2015. All 17 patients (20 eyes) completed the Munk score preoperatively and at 3 months postoperatively. Patients subjectively scored their epiphora severity based on the 0–4 scale, where. is no watering and. is constant watering. Statistical analysis was carried out using paired T-test. Average Munk score prior to lid surgery was 4.65 ± 0.49 SD (median = 5) and 2.05 ± 1.05 SD (median = 2) postoperatively. The mean difference in preoperative and postoperative Munk score was 2.6 ± 1.05 SD (median = 3, p < 0.001, 95% CI 2.11–3.09). Only one patient had no change in their Munk score following lateral tarsal strip surgery, scoring. both pre and postoperatively.

Our study findings compare with those from Sipkova et al. [1], where their patients also showed significant improvement in Munk score following lid-tightening surgery (p < 0.001). In our experience, the Munk score can be applied realistically during busy outpatient clinical settings in view of its ease of completion. However, the Munk score has its limitations in assessing the impact of epiphora on specific daily tasks. For example, our single patient who did not show improvement in Munk score may have had very severe frequency of wiping from 50 times. day preoperatively (Munk score of 4) to 20 times. day postoperatively (Munk score of 4), an improvement for the patient. We therefore support Sipkova et al. [1] in their notion for the development of. validated PROM questionnaire for use following non-DCR, surgical intervention for epiphora.