Lacrimal (M1)

Question 1

Problems with what areas are considered external disease leading to epiphora?

Answer 1

1. lids
2. ocular surface
3. lashes
4. inferior tear prism
5. puncta

Question 2

What makes up the upper system of the nasolacrimal duct?

Answer 2

1. external
2. puncta
3. canaliculi
4. lacrimal sac

Question 3

What makes up the lower system of the nasolacrimal duct?

Answer 3

1. lacrimal sac

2. valve of Hasner

Question 4

What lid margin abnormalities can cause epiphora?

Answer 4

1. ectropion
2. lid laxity
3. entropion

Question 5

What punctal obstructions can cause epiphora?

Answer 5

1. conjunctivochalasis

2. large caruncle

Question 6

If a patient is having epiphora and their drainage system is completely open what is the most likely cause?

Answer 6

dry eye (reflex tearing)

Question 7

What is to be expected while probing the nasolacrimal duct if there is an obstruction?

Answer 7

soft stop (tissue stoping flow)

Question 8

While probing the nasolacrimal duct, if there is regurgitation from the opposite canaliculus what does it indicate?

Answer 8

1. patency of opposite canalicular system
2. common canalicular block
3. lower system block in either lacrimal sac or nasolacrimal duct

Question 9

What does the Dye disappearance test (DDT) consist of? 1. What determines if there is a blockage? 2

Answer 9

1. one drop of 2% fluorescein in both eyes and compare. 5-10 minute clearance then look
2. If one eye has more in the eye it may be blocked

Question 10

What is the value during the Shirmer test that indicates epiphora?

Answer 10

> 10mm in 5 minutes

Question 11

What is the process involved in the Jones I Test of Epiphora? 1. What does a positive test mean and how does it appear? 2. Negative test? 3

Answer 11

1. Instill fluorescein and inspect nose for dye
2. Means hypersecretion and has fluorescein in tissue
3. Means obstruction and doesn’t have fluorescein

Question 12

What is the process involved in the Jones II Test of Epiphora? 1. What does a positive test mean and how does it appear? 2. Negative test? 3

Answer 12

1. Rinse out fluorescein from Jones I, dilate/irrigate, and inspect for dye
2. partial obstruction in lower portion of nasolacrimal duct; has dye
3. partial canalicular/punctum obstruction in upper portion; no dye present

Question 13

What is the treatment that creates a hole in the lacrimal sac to the medial nasal meatus?

Answer 13

Dacryocystorhinostomy