Clinical and radiologic lacrimal testing in patients with epiphora.

Abstract

The purpose of the study is to assess the strengths and weaknesses of selected clinical and radiologic lacrimal tests in patients with epiphora. The study design was a prospective clinical trial. Fifteen patients with epiphora (N = 27 eyes) were studied. All patients underwent Jones testing, the dye disappearance test, canalicular probing, lacrimal scintigraphy, and macrodacryocystography. The dye disappearance test was graded individually by three ophthalmologists. Lacrimal scintigraphy and macrodacryocystography were evaluated by a nuclear medicine specialist and a radiologist, respectively. A panel of three ophthalmologists evaluated the data using a scoring system that relied on the preponderance of evidence to arrive at a final assessment. When the Jones I test results were negative (dye recovered from the nose), the epiphora was always from hypersecretion. When the Jones I test results were positive (no dye recovered from the nose), obstruction was not always present. When the dye disappearance test results were strongly abnormal, obstruction was always present. In contrast, when the dye disappearance test results were normal, the lacrimal drainage system was not always patent. Canalicular probing was more reliable than scintigraphy in identifying canalicular obstruction. Marked stenosis of the sac or duct on dacryocystography essentially confirmed nasolacrimal outflow obstruction; however, with the authors' technique, a normal study was found in some patients with functional or partial obstruction. More than one lacrimal test may be required for a definitive diagnosis in patients with epiphora due to partial or functional nasolacrimal outflow obstruction.