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A Modified Jones Test: Lacrimal Scintigram Correlation

Paramanathan, Nirosha M.B.B.S.; Nemet, Arik M.D.; Lee, Scott E. M.D., M.P.H.; Benger, Ross S. M.B.B.S., F.R.A.N.Z.C.O.

Ophthalmic Plastic & Reconstructive Surgery: March-April 2011 - Volume 27 - Issue 2 - p 81-86
doi: 10.1097/IOP.0b013e3181c8ab70
Original Investigations

Purpose: To determine the correlation between lacrimal scintigraphy and a modified Jones primary dye drainage test combined with the fluorescein dye disappearance test (DDT) and Jones secondary dye test, in diagnosing the cause of epiphora.

Methods: A prospective, consecutive clinical trial was conducted. All patients presenting with epiphora were considered, but those with trichiasis, corneal irritation, lower eyelid ectropion, Bell palsy, or previous lacrimal surgery were excluded. A cohort of 39 patients (65 eyes) underwent the fluorescein DDT and the senior author's (R.B.) modified Jones primary dye drainage test (Jones dye test 1 [JDT1]). For this test, an entire fluorescein 2% Minim dose was instilled in the 2 eyes, and the patient was then asked to gently blow each nostril separately in a white tissue; the degree of fluorescein staining was noted. If there was no fluorescein staining of the tissue (negative JDT1), a traditional Jones secondary dye test (Jones dye test 2) was also performed. All patients except for those testing strongly positive on modified testing or with negative DDT and JDT1 and nil drainage from the nose in Jones dye test 2, indicating anatomical obstruction, were referred for lacrimal scintigraphy.

Results: In total, 59 of 65 eyes (91%) showed a positive correlation between the diagnosis arrived at after dye testing using the modified primary dye test and diagnosis on lacrimal scintigraphy. The interrater reliability for the raters was found to be κ = 0.770 and 95% confidence interval = 0.594–0.945. The strength of agreement is considered to be “good.”

Conclusions: The authors found that in the presence of patent lacrimal drainage system dysfunction, modified Jones primary dye test, combined with the fluorescein DDT and Jones secondary dye test, correlated strongly with lacrimal scintigraphy.

A modified Jones primary dye test, combined with the fluorescein dye disappearance test and Jones secondary dye test, showed a high degree of confidence in clinically diagnosing the cause of epiphora, when correlated with the findings of lacrimal scintigraphy.

Drummoyne Eye Surgical Centre, Sydney, Australia

Accepted for publication October 21, 2009.

The authors declare no conflict of interests.

Address correspondence and reprint requests to Ross S. Benger, M.B.B.S., F.R.A.N.Z.C.O., Drummoyne Eye Surgical Centre, 250 Victoria Road, Drummoyne, New South Wales 2047, Australia. E-mail:

©2011The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.