Some work-up examination that is used to establish the diagnosis of Obstruction

Nasolacrimal Duct :

A. Tear Duct Production : The tear duct production test is to measure whether
the possible tear reflex tearing are caused by tear deficiency or instability.
Schirmer Test 1
i. Without topical anesthetic: Without topical anesthetic (stimulated tear
production): Normal measurement is 10-30 mm wetting of Schirmer strip after 5
minutes.
ii. With topical anesthesia (basic secretion): Normal measurement is greater than 5
mm of wetting of Schirmer strip paper after 5 minutes.

B. Fluorescein dye disappearance test: A screening tool to indicate a partial or complete obstruction
or pump failure. A positive result is indicated by +2 to +4 residual fluoroscein5 minutes after
instillation. 1
C. Lacrimal Irrigation : Reflux of irrigating fluid in the opposite/upper punctum
demonstrates patency of the canalicular system but suggests obstruction in
the distal drainage system.1
D. Dacryocystography: An imaging study that use to show the visualization of anatomic details
of the lacrimal drainage system using contrast material. 1

Dacryocystogram. A patent nasolacrimal system on the right side of a patient and a blocked system on the contralateral
side at the level of the nasolacrimal duct.

E. Dacryoscintigraphy: More sensitive and less invasive method of lacrimal system

imaging. An effective modality in diagnosing abnormalities of the lacrimal
system that cause epiphora (pathological overflow of tear) 2.
Reference:

1.Camara JG. Obstruction Nasolacrimal Duct [Internet]. [Place Unknown]: Medscape;

2012 [updated 2012 February 9; citied 2014 August 6]. Available from:
http://emedicine.medscape.com/article/1210141-workup

2. Yong An Chung, Ie Ryung Yoo, Joung Sik Oum, et al. The clinical value of
dacryoscintigraphy in the selection of surgical approach for patients with functional
lacrimal duct obstruction. Annals of Nuclear Medicine. 2005; 19(6):479-83.