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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

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Anatomy of lacrimal drainage system:

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WHY TO TEST FOR PATENCY?

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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