Taking the crying out of an epiphora exam
Michael S. Ehrlich, MD, explains how a simple lacrimal irrigation technique not only can avoid unnecessary discomfort for patients, but also adds diagnostic value for ophthalmologists.
Take Home: Michael S. Ehrlich, MD, explains how a simple lacrimal irrigation technique not only can avoid unnecessary discomfort for patients, but also adds diagnostic value for ophthalmologists.
Plastics Pearls By Michael S. Ehrlich, MD
New Haven, CT-Excessive tearing, or epiphora, is a common chief complaint in general and
Causes of epiphora can be broadly classified into ocular surface disorders, eyelid malposition, nasolacrimal duct obstruction, and canalicular obstruction. Extensive history taking should be undertaken to narrow down the differential diagnosis. Specific questions of medication history, sinus disease, trauma, infection, and chronicity can be helpful.
Even after a careful history, however, the majority of these patients require lacrimal irrigation to determine the anatomic cause of the patients’ symptoms, as well as to formulate a medical and/or surgical plan.
Patients are often referred to our subspecialty practice having previously undergone diagnostic lacrimal irrigation in the past. After explaining that it is necessary to irrigate their lacrimal system not only to confirm a blockage, but also to observe the pattern of reflux, patients are often still hesitant. Why?
The traditional method of dilation and irrigation can be quite uncomfortable. A simple irrigation technique is one that patients report to be comfortable and that I find to add diagnostic value.
Traditional lacrimal irrigation cannulas range in size from 21 to 25 gauge. This large size often requires the punctum and upper canaliculus to be dilated before the cannula will fit. Once dilated, the large size of the cannula requires a 90° turn laterally to allow laminar flow into the lacrimal system. Patients may report significant painful pressure during both dilation and irrigation.
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