Tests done to assess patency of lacrimal drainage

OPTHAL MEDICAL

1. 31/08/2015 1 TESTS DONE TO ASSESS PATENCY OF LACRIMAL DRAINAGE SYSTEM

2. CONTENTS 31/08/2015 2 1.Introduction 2.Why to test for patency? 3.Clinical examination 4.ROPLAS 5.FDDT 6.Probing 7.Lacrimal syringing 8.Jones test I AND II 9.Dacryocystography 10.Lacrimal scintillography

3. INTRODUCTION 31/08/2015 3 Anatomy of lacrimal drainage system :

4. WHY TO TEST FOR PATENCY? 31/08/2015 4 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).

5. CLINICAL EXAMINATION 31/08/2015 5 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.

6. ROPLAS TEST 31/08/2015 6 Apply steady pressure with index finger over the lacrimal sac area. Look for regurgitation of mucopurulent discharge from the puncta . It signifies patent canalicular system w ith block in lower end of sac or NLD

7. FLUORESCEIN DYE DISAPPEARANCE TEST 31/08/2015 7 Instill 2 drops of fluorescein dye in the conjunctival sac and observe after 2 minutes Normally no dye is seen Prolonged retention of dye indicate inadequate drainage due to atonia of the sac or mechanical obstruction.

8. PROBING 31/08/2015 8 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)

9. LACRIMAL SYRINGING 31/08/2015 9 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 saline Look for regurgitation and ask the patient for flow into the nose.

10. JONES TEST I 31/08/2015 10 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

11. JONES TEST II 31/08/2015 11 If Jones I is negative,do Jones II Place a bud similarly and perform lacrimal syringing Positive test-watering is due to a functional lacrimal pump failure Negative test-indicate a mechanical obstruction

12. DACRYOCYSTOGRAPHY 31/08/2015 12 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 minutes Substraction macrodacryocystography

13. LACRIMAL SCINTILLOGRAPHY 31/08/2015 13 Non invasive technique Radionucleotide dacryocystography Instill a radioactive tracer( sulphur colloid or Tc ) into conjunctival sac Its passage through lacrimal drainage system is visualized with an anger gamma camera

14. REFERENCES 31/08/2015 14 PARSONS’ DISEASES OF THE EYE, 20 TH edition. Comprehensive ophthalmology by A.K.KHURANA, 5 TH edition Essentials of ophthalmology by SAMAR K BASAK, 5 th edition

15. THANK YOU 31/08/2015 15