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Assessing Patients With Epiphora Who Are Patent to Syringing: Clinical Predictors of Response to Dacryocystorhinostomy

O’Donnell, Brett A. M.B.B.S., F.R.A.N.Z.C.O., F.R.A.C.S., F.R.C.Ophth.*†; Clement, Colin I. M.B.B.S., Ph.D.*

Ophthalmic Plastic & Reconstructive Surgery: May-June 2007 - Volume 23 - Issue 3 - p 173-178
doi: 10.1097/IOP.0b013e31803e1744

Purpose: To assess the value of an abnormal fluorescein dye disappearance test (FDDT), lacrimal syringing, and Jones test for patients with epiphora who are clinically patent to syringing.

Methods: Prospective cohort study of 68 consecutive patients with epiphora who were clinically patent to syringing and otherwise normal to examination. Patients were assessed using FDDT and lacrimal syringing, as well as the Jones test comparing either single- or multiple-drop technique. FDDT and canalicular reflux on lacrimal syringing were subjectively graded.

Results: Success was defined as nil or only mild epiphora after surgery. Surgery was performed on 68 patients with a successful result in 64 (94%). The majority of these patients had severely delayed FDDT (90%), ≥50% reflux on lacrimal syringing (78%), or were Jones I negative (81%). There was no significant difference between outcomes of the single- and multiple-drop tests. In patients examined with the single-drop Jones test, patients with a Jones I negative result had a statistically significant better surgical outcome (p = 0.04). This comparison was highly significant when the subgroup of patients with severely delayed/nonclearing FDDT and ≥50% reflux was examined (p = 0.005). The results were not significant for the multiple-drop group.

Conclusions: These findings show that a negative single-drop Jones I test is predictive of symptomatic improvement after dacryocystorhinostomy surgery in patients with epiphora who are clinically patent to syringing. Lacrimal syringing and the FDDT, on their own, were not predictive of surgical outcome. Jones testing was of significant value in patients, but only when the traditional single-drop test was used.

The combination of a negative Jones I test, 50% or greater canalicular reflux, and delayed/nonclearing fluorescein dye disappearance test was strongly correlated with excellent symptom improvement after surgery.

*Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia; †Department of Ophthalmology, St. Vincent’s Hospital, Sydney, New South Wales, Australia

Accepted for publication November 6, 2006.

Address correspondence and reprint requests to Dr. Brett A. O’Donnell, Suite 3, Level 2, North Shore Medical Centre, 66 Pacific Highway, St. Leonards NSW 2065, Australia. E-mail:

©2007The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.