What would be the tests for assessment in a patient presenting with the condition shown in the image ,unilaterally?
A. Lacrimal Irrigation
B. Jone’s Dye tests
C. Punctal dilatation and canalicular probing.
D. All of the above
Ans:D. All of the above
The patient is presenting with unilateral Epiphora
- Excessive tearing could be caused by hypersecretion from the tear glands or insufficient drainage of tears through the lacrimal drainage system.
- In epiphora due to overproduction of tears, the problem will be bilateral.
- Tearing due to insufficient drainage will be mostly unilateral.
Assessment of Lacrimal System
- Punctal ectropion may be associated with epiphora. Each punctum should be assessed for patency. Normal punctum is usually 0.3 mm in diameter
- Palpation over the medial canthal area may reveal a mass in the area of lacrimal sac, in patients with significant lower tear drainage channel obstrution.
- Schirmer’s test: This test is basically prepared to quantitate tear production. Normal test result is between 10mm and 30 mm of wet filter paper. Normally it should not exceed 30 mm. A value of more than 30 mm is considered to be epiphora. A value of less than 10 mm is considered to be dry eye (hyposecretion).
- Fluorescein dye disappearance test: A mixture of topical anesthetic and flurescein dye is placed in the inferior fornix of each eye. The tear film formed in each eye is observed and compared over a period of 5 – 10 minutes. This dye should drain rapidly through a patent lacrimal drainage system. Persistence of dye in the tear film even after 10 minutes indicates abnormal lacrimal outflow.
- Punctal dilatation and canalicular probing: This simple test is used to evaluate patency of the proximal ductal system. Difficulty with dilatation may indicate clinically significant punctal stenosis. Similarly difficulty with probing through the canaliculus may indicate canalicular stenosis / stricture. Easy probing up to the superior portion of lacrimal sac is a good indicator of upper lacrimal drainage pathway patency.
- Lacrimal irrigation: This test is used to diagnose the location and extent (complete / partial) of an obstruction. A 23 – 27 gauge cannula is attached to a syringe containing sterile saline solution. This is introduced into the proximal canaliculus (usually the lower one) following punctal dilatation.Reflux of the injected saline through the same punctum indicates canalicular obstruction, while reflux from the opposite punctum indicates obstruction distal to the common canaliculus. Distention of lacrimal sac or reflux of purulent secretion indicates nasolacrimal duct obstruction.
- Jones dye tests: This group of tests are used to distinguish between functional and anatomic outflow problems.