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Management of dysfunctional tearing starts with evaluation
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WAILEA, Hawaii – Probing and irrigation gives clues to where blockages may lie and is the place to start when evaluating patients with increased lacrimation and decreased drainage, according to a speaker.
George B. Bartley
Further elements of the evaluation include the dye disappearance test, Jones dye tests, dacryoscintigraphy and dacryocystography, George B. Bartley, MD, said at the Hawaiian Eye 2015 meeting.
Dacryoscintigraphy defines lacrimal drainage function, whereas dacryocystography, which is a little more cumbersome, he said, defines lacrimal drainage anatomy.
“It’s very helpful if you have a question about anatomy of the lacrimal drainage system, if you’re thinking about doing a dacryocystorhinostomy. It helps you know what you’re getting into,” Bartley said.
Once increased lacrimation is evaluated, the next step in management is to correct the underlying disorder, Bartley said. For cases of decreased drainage, there are more options: lid tightening, ectropion repair, punctoplasty/ampullotomy, silicone lacrimal intubation, darcryocystorhinostomy and conjunctivodacryocystorhinostomy (CDCR) with Jones tube.
“CDCR with a Jones tube kind of gets a bad rap,” Bartley said. “Over the years, I’ve rediscovered it. … These work. Don’t negate these.”
The timing of stent removal after dacryocystorhinostomy is a matter of controversy, he said.
“I used to leave them in pretty much forever,” he said. “But with the advent of research on biofilms, I’ve changed my tune on that. … I take them out now, arbitrarily, about a month after surgery.” –
Disclosure: Bartley reports no relevant financial disclosures.