Which tests are performed to evaluate nasolacrimal duct obstruction (NLDO)?

Which tests are performed to evaluate nasolacrimal duct obstruction (NLDO)?

• A. Palpate lacrimal sac (punctal mucoid discharge), Jones I, Jones II.
• B. Schirmer test, tear film breakup time, corneal staining.
• C. Visual acuity, refraction.
• D. Intraocular pressure measurement.

Answer: (A)

Evaluating NLDO centers on whether tear drainage from the eye into the nasal cavity is working. Palpating the lacrimal sac helps assess the drainage pathway directly: if the lacrimal sac is distended and pressing on it causes regurgitation of tears or discharge through the puncta, this points to a blockage in the nasolacrimal drainage system. The Jones tests are functional checks of the tear drainage route. Instilling fluorescein dye in the eye and seeing whether dye appears in the nasal cavity after a few minutes (Jones I) tests overall patency from eye to nose; if the dye is present, the pathway is patent, whereas absence suggests NLDO or a proximal obstruction. If Jones I is negative, Jones II uses irrigation to differentiate where the blockage lies and to confirm whether dye can reach the nose after forced drainage. The other options don’t target the lacrimal drainage system: those tests assess tear film and ocular surface health (Schirmer, TBUT, corneal staining) or simply measure vision and eye parameters (visual acuity, refraction, intraocular pressure).

Evaluating NLDO centers on whether tear drainage from the eye into the nasal cavity is working. Palpating the lacrimal sac helps assess the drainage pathway directly: if the lacrimal sac is distended and pressing on it causes regurgitation of tears or discharge through the puncta, this points to a blockage in the nasolacrimal drainage system. The Jones tests are functional checks of the tear drainage route. Instilling fluorescein dye in the eye and seeing whether dye appears in the nasal cavity after a few minutes (Jones I) tests overall patency from eye to nose; if the dye is present, the pathway is patent, whereas absence suggests NLDO or a proximal obstruction. If Jones I is negative, Jones II uses irrigation to differentiate where the blockage lies and to confirm whether dye can reach the nose after forced drainage.

The other options don’t target the lacrimal drainage system: those tests assess tear film and ocular surface health (Schirmer, TBUT, corneal staining) or simply measure vision and eye parameters (visual acuity, refraction, intraocular pressure).