Diagnostic accuracy of fluorescein dye disappearance test in comparison with lacrimal syringing in evaluation of epiphora

Abstract

Epiphora is the overflow of tear in the lid margin. It can be due to hyper secretion or inadequate tear drainage. Inadequate drainage of tears may be due to mechanical or physiological causes. Physiological cause is due to lacrimal pump failure or weakness of orbicularis muscle. Mechanical causes are due to obstruction in the lacrimal passages. Evaluation of epiphora can be done by lacrimal syringing, fluoresceine dye disappearance test, Jones dye test, contrast dacryocystography, nuclear lacrimal scintigraphy, CT, MRI etc. Fluoresceine dye test is a non invasive method to study tear flow drainage system. Our study evaluate the effectiveness of dye disappearance test to lacrimal syringing which is a invasive test. Aim of this study was to evaluate the accuracy of fluorescein dye disappearance test [FDDT] in evaluating epiphora in comparison to lacrimal syringing.: A prospective observational study was conducted in 90 consecutive patients of age group of 40 to 70 years who presented with epiphora in Department of ophthalmology at tertiary care centre. Any cause like foreign body, trauma, blepharitis, lid disorders like ectropion, entropion, history of lacrimal sac surgeries in the recent past, and allergy to sodium fluorescein excluded from the study.A thorough medical history and comprehensive ophthalmological examination done in all patients. Epiphora evaluated with regurgitation over pressure on the lacrimal sac area, lacrimal syringing, and fluorseceine dye disappearance test.FDDT resulte were graded as grade 1 to 4 according to the quantity of flouorseceine stain in the conjunctival sac, Grade 1 and 2 considered as normal and grade 3 and 4 considered as abnormal.Results of FDDT, syringing, ROPLAS compared in the patients with epiphora.: In the study group, the 90 samples were analysed. The sample population were 62% males and 38% females. There were co-morbidities like diabetes mellitus and cataract noticed in the population. When we examined the diabetes mellitus patients presented with epiphora, showed lacrimal passage obstruction is more common in diabetes patients [67% patients among diabetes patients have FDDT of grade 2-3]. Regurgitation on pressure over lacrimal sac] test were done in all patients presented with epiphora, and the test was positive in 21 patients. FDDT were done in these patients and the results showed only 14 patients were Grade 2-3 [67%]. We compared the FDDT and lacrimal syringing tests in epiphora patients. Among the 90 patients we found that 60 individuals had patent nasolacrimal passages, verified by free flow in Lacrimal syringing test. FDDT showed majority of the patients were under grade 0-1 [patent nasolacrimal passages]. The patients with blocked nasolacrimal passages verified by lacrimal syringing were found grade 2-3 in FDDT [Blocked nasolacrimal passages]. Sensitivity, specificity, and positive and negative predictive value of FDDT were calculated.: FDDT is a safe and effective test for the evaluation of epiphora. It can be done as a screening test in pre operative evaluation of cataract surgery.