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Tearing

 
  1. Lacrimation                
  2. Epiphora
Epiphora – Causes:
  1. Anatomical –Obstruction of the puncta or canaliculi        
    1. Strictures         
    2. Obstruction          
    3. F.B.          
    4. Tumour
  2. Physiological
     
    Lacrimal pump failure (facial nerve palry)
Table: Obstructive lesions of the lacrimal passages
Site of obstruction Clinical features Syringing Jones test Treatment
Single canaliculus Pouting or narrowing of punctum, 'soft stop' on probing
 
Regurgitation through the same canaliculus
 
Test 1: may be positive if other canaliculus normal Astringent drops
Both canaliculi 'Soft stop' on probing
 
Regurgitation through the same canaliculus Test 1 and 2: negative Conjunctivodacryo cysto rhinostomy with jones tube
Common canaliculus 'Soft stop' on probing
 
Immediate regurgitation through the opposite canaliculus Test 1 and 2: negative Canaliculodacryocysto rhinostomy
Complete nasolacrimal duct Regurgitation on pressure over the
lacrimal sac, 'hard
stop' on probing
 
Regurgitation through the opposite canaliculus after some time
 
Test 1 and 2: negative Dacryocystorhinostomy: transcutaneous or endonasal
Partial nasolacrimal duct Regurgitation on pressure over the
lacrimal sac, 'hard stop' on probing
Regurgitation
Through the opposite canaliculus after
some time, some fluid in the nose with pressure syringing after blocking the opposite canaliculus
 
Test 1: some fluorescein in nose Pressure syringing with antibiotics
Functional nasolacrimal duct or lacrimal pump failure No regurgitation
 
Patent Test 1: negative
Test: 2 positive
 Astringent drops




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