Post on 14-Feb-2017
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31/08/2015
TESTS DONE TO ASSESS PATENCY OF LACRIMAL DRAINAGE SYSTEM
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CONTENTS
31/08/2015
1.Introduction 2.Why to test for patency?3.Clinical examination4.ROPLAS5.FDDT6.Probing7.Lacrimal syringing8.Jones test I AND II9.Dacryocystography10.Lacrimal scintillography
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INTRODUCTION
31/08/2015
Anatomy of lacrimal drainage system:
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WHY TO TEST FOR PATENCY?
31/08/2015
In a case of watering of eyes, we need to differentiate between excess secretion (hyperlacrimation) and defective drainage (epiphora).
If it is epiphora we need to assess the cause-functional lacrimal pump failure or obstruction(site, degree, and cause).
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CLINICAL EXAMINATION31/08/2015
Ocular examination with a slit-lamp using magnification to exclude punctal causes of obstruction like stenosis, foreign body, etc.
Any swelling in the sac area to be noted.Also any cause for reflex hypersecretion to be
noted.
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ROPLAS TEST
31/08/2015
Apply steady pressure with index fingerover the lacrimal sac area.Look for regurgitation of mucopurulent discharge from the puncta.It signifies patent canalicular system with block in lower end of sac or NLD
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FLUORESCEIN DYE DISAPPEARANCE TEST
31/08/2015
Instill 2 drops of fluorescein dye in the conjunctival sac and observe after 2 minutes
Normally no dye is seenProlonged retention of dye indicate inadequate drainage due to atonia of the sac or mechanical obstruction.
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PROBING
31/08/2015
Pass a blunt tipped probe medially through puncta, canaliculus and sac till probe comes to a stop
HARD STOP-is normal(lacrimal bone is felt)SOFT STOP-due to an obstruction(canalicular or sac level)
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LACRIMAL SYRINGING
31/08/2015
Use topical anaesthetic- 4% xylocaine. Dilate the lower puncta with lacrimal dilator.
Cannula inserted into puncta and vertical canaliculus, pull the lid temporally allowing entry into horizontal part.
Inject sterile salineLook for regurgitation and ask the patient for flow into the nose.
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JONES TEST I
31/08/2015
Instill 2 drops 2% fluorescein dye in the conjunctival sac, place a cotton bud dipped in 1% xylocaine in the inferior meatus, inspect the bud after 5 minutes.
Stained bud-Positive test- indicate patent passages (may be hypersecretion)No staining- Negative test
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JONES TEST II
31/08/2015
If Jones I is negative,do Jones IIPlace a bud similarly and perform lacrimal
syringingPositive test-watering is due to a functional
lacrimal pump failureNegative test-indicate a mechanical obstruction
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DACRYOCYSTOGRAPHY
31/08/2015
To visualize the passage and know the exact site, nature and extent of block.
Inject radioopaque material like lipiodol, pentaopaque in the sac with a lacrimal cannula
Take X-rays after 5 and 30 minutesSubstraction macrodacryocystography
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LACRIMAL SCINTILLOGRAPHY
31/08/2015
Non invasive techniqueRadionucleotide dacryocystographyInstill a radioactive tracer(sulphur colloid or
Tc) into conjunctival sacIts passage through lacrimal drainage system
is visualized with an anger gamma camera
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REFERENCES
31/08/2015
PARSONS’ DISEASES OF THE EYE, 20TH edition.
Comprehensive ophthalmology by A.K.KHURANA, 5THedition
Essentials of ophthalmology by SAMAR K BASAK, 5th edition
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THANK YOU
31/08/2015