Evaluation and Imaging of Lacrimal Drainage Disorders

The lacrimal drainage system is a mucous membrane-lined duct whose function results from the interplay of anatomy and physiology. The presence of epiphora depends on the balance between tear production and tear drainage, not the absolute status of either. No single evaluation test will localize the anatomic site of blockage or the physiologic basis for the imbalance between tear production and tear drainage. A detailed combination of external examination and one or more clinical tests will usually uncover the correct etiology of drainage dysfunction. In some difficult cases, imaging techniques will enhance the reliability of the diagnosis and permit an appropriate management strategy. The most common clinical tests include the dye disappearance test, the Schirmer test, and the Jones I and II tests. The most useful imaging techniques are dacryocystography, dacryoscintigraphy, CT and MRI scans, and ultrasonography.