{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:51:47Z","timestamp":1791906707597,"version":"4.3.4"},"reference-count":12,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,5,29]],"date-time":"2022-05-29T00:00:00Z","timestamp":1653782400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100013116","name":"Merz Pharmaceuticals","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013116","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Thea Pharmaceuticals"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Ophthalmology"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To test the reliability, validity and utility of the TEARS score, a scale of clinical and patient-reported severity in patients with epiphora, comprising 4 subscales: Times wiping (T), clinical Effects (E), Activity limitation (A), and symptoms of Reflex epiphora (R).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The TEARS score was completed by 136 patients with epiphora (78 treated surgically, and 51 non-surgically). Inter-rater reliability was evaluated using Cohen's Kappa and Bland-Altman analysis. 129 (95%) participants were followed up 2\u20136 months after baseline (non-surgical patients) or 3\u20136 months post-operatively (surgical patients). For each TEARS subscale, differences in scores were compared. Convergent validity was evaluated by testing correlation between TEARS and both The Lacrimal Symptom Questionnaire (Lac-Q) and The Watery Eye Quality of Life Score (WEQOL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Inter-rater reliability (Cohen's K) ranged from 0.5 for \u2018A\u2019 and \u2018R\u2019 to 0.8 for \u2018T\u2019 and \u2018E\u2019 subscales. Scores were lower post-operatively in surgical patients (p\u2009&lt;\u20090.001). \u2018R\u2019 scores (reflex tearing) were higher in non-surgical cases compared with surgical (p\u2009=\u20090.02) but no difference was observed in other subscales at baseline. TEARS subscale scores were positively correlated with both WEQOL (r\u2009=\u20090.51 to 0.73) and Lac-Q score (r\u2009=\u20090.55 to 0.63).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The TEARS score is quickly and easily implemented in a busy clinical setting. It provides an overview of both subjective and objective clinical severity in patients with epiphora, with appropriate reliability, post-operative responsiveness and convergent validity for this purpose and in this setting. It is a valuable template to be used alongside individualised symptomology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11206721221104550","type":"journal-article","created":{"date-parts":[[2022,5,30]],"date-time":"2022-05-30T02:22:51Z","timestamp":1653877371000},"page":"2108-2115","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["The \u2018tears\u2019 score: A tool for grading and monitoring epiphora"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0833-1520","authenticated-orcid":false,"given":"Christopher B.","family":"Schulz","sequence":"first","affiliation":[{"name":"Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK of Great Britain and Northern Ireland"},{"name":"Department of Ophthalmology, Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO6 3LY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raman","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK of Great Britain and Northern Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,5,29]]},"reference":[{"key":"bibr1-11206721221104550","first-page":"649","volume":"105","author":"Woog JJ","year":"2007","journal-title":"Trans Am Ophthalmol Soc."},{"key":"bibr2-11206721221104550","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1111\/j.1442-9071.2012.02866.x","volume":"41","author":"Sibley D","year":"2013","journal-title":"Clin Exp Ophthalmol"},{"key":"bibr3-11206721221104550","doi-asserted-by":"publisher","DOI":"10.1080\/01676830590897155"},{"key":"bibr4-11206721221104550","unstructured":"Schulz C, Makuloluwe S, Rogers S. Issues affecting quality of life in patients with epiphora. Presented at the European Society of Ophthalmic Plastic and Reconstructive Surgeons September 2017."},{"key":"bibr5-11206721221104550","doi-asserted-by":"publisher","DOI":"10.1097\/IOP.0000000000000977"},{"key":"bibr6-11206721221104550","unstructured":"Schulz C, Malhotra R. Grading the clinical severity of epiphora: the TEARS score. Presented at the British Oculoplastic Surgery Society Annual Meeting.\n                      Thyroid and Lacrimal Session\n                      2018; 118."},{"key":"bibr7-11206721221104550","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.177.3.2243969"},{"key":"bibr8-11206721221104550","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino11.042"},{"key":"bibr9-11206721221104550","author":"Schulz CB","year":"2021","journal-title":"Eye"},{"key":"bibr10-11206721221104550","doi-asserted-by":"publisher","DOI":"10.4193\/Rhino13.041"},{"key":"bibr11-11206721221104550","doi-asserted-by":"publisher","DOI":"10.1177\/001316446002000104"},{"key":"bibr12-11206721221104550","doi-asserted-by":"publisher","DOI":"10.4135\/9781412963947"}],"container-title":["European Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11206721221104550","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11206721221104550","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11206721221104550","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T19:44:02Z","timestamp":1777405442000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11206721221104550"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,29]]},"references-count":12,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1177\/11206721221104550"],"URL":"https:\/\/doi.org\/10.1177\/11206721221104550","relation":{},"ISSN":["1120-6721","1724-6016"],"issn-type":[{"value":"1120-6721","type":"print"},{"value":"1724-6016","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,29]]}}}