Tearing Evaluation
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History of Symptoms
At Idaho Eyelid and Facial Plastic Surgery, we evaluate many patients that have epiphora, or watering of the eyes. During the initial exam, we determine if the tearing problem is unilateral or bilateral. We then take patient history of nasal, sinus, or facial fractures or surgeries that might have complicated the lacrimal system. We further investigate whether the patient has blood in the tears, pain, or inflammation. We also determine past or present history of nasal polyps/sinusitis, hay fever/allergies, ocular irritation due to external influences, and/or Bell’s palsy.
Etiologies of Epiphora
There are a number of conditions that cause epiphora including surface irritation causing reactive hypersecretion, outflow obstruction, first degree idiopathic hyper-secretion, or external/corneal disease pseudo epiphora. When the tears do not run down the cheek, our practice evaluates for: dry eye syndrome, conjunctivitis, blepharitis, uveitis, entropion, trichiasis, thyroid eye disease, sinusitis, and/or hay fever. It is also important to determine if a patient has had dental work or has central nervous system issues that could exacerbate tearing problems. Inadequate drainage may be apparent through a stiff lid caused by burns, scar tissue, or scleroderma. Lacrimal pump dysfunction or punctal displacement may cause occlusion. Other causes include conjunctivochalasis, canalicular problems which may or may not be congenital.
Examination of the Lacrimal System
Lacrimal system drainage issues are common. At Idaho Eyelid and Facial Plastic Surgery, we examine our patients by assessing the eyelids for lid laxity and malposition, investigating the lacrimal puncta, canaliculi, and nacolacrimal duct for obstruction. We probe and irrigate until we find the source of the blockage.
Primary Dye Test
Fluorescein staining is a technique used to assess the volume of the tear film in the meniscus. This dye glows under a blue light, so adding it to saline and a dropping it into the eyeball can help determine if a patient has a total or partial tear duct blockage.
Irrigation (Jones I)
Irrigation through Jones I helps estimate tear flow through the lacrimal system. A topical anesthetic is used and lower punctal dilation and irrigation is performed to determine partial or complete nasolacrimal duct obstruction.
Secondary Dye Test = Informal Jones II
Irrigation through Jones II involves the presence of dye in the nose, which points to functional nasolacrimal duct obstruction.
Probing
Probing is performed diagnostically in the adult upper lacrimal system consisting of the puncta, canaliculi, and lac sac to determine the level of obstruction.
Dacryocystogram (DCG)
A dacryocystogram (DCG) is an imaging exam that uses x-rays and a contract dye to examine tear ducts for blockage.
CT
A CT scan can help diagnose tearing issues in the lacrimal system by showing the anatomy of the tear ducts and surrounding lacrimal system to determine blockages.
Terms
Epiphora: Patients who have epiphora have excessive watering of the eyes, pointing to an imbalance between production and drainage of tears.
