Question

Your patient reports constant epiphora of the right eye. You wish to determine if there is a blockage of her tear drainage system. You perform lacrimal irrigation. During the procedure, the plunger of the cannula is depressed with great difficulty, and the fluid is regurgitated through the puncta that you are irrigating. What is the CORRECT interpretation of these findings?

There is a blockage that is proximal to the common caniculus
There is an obstruction of the lacrimal duct of the opposite eye
The passageway is clear; there is no obstruction at this time
There is a blockage that is distal to the common caniculus

Answer 1

Difficult plunger depression during lacrimal irrigation and regurgitation of fluid through the puncta indicate a blockage distal to the common canaliculus in the tear drainage system.

Step-by-step explanation:

When performing a lacrimial irrigation and experiencing great difficulty in depressing the plunger of the cannula, with the fluid regurgitated through the puncta being irrigated, it indicates that there is an obstruction within the tear drainage system. The correct interpretation of these findings is that there is a blockage that is distal to the common canaliculus. The common canaliculus is a part of the lacrimal drainage system that transports tears from the lacrimal puncta, which are small openings for tear drainage, to the lacrimal sac before moving into the nasolacrimal duct. Therefore, if the irrigation fluid is backing up and out of the same punctum it was introduced into, it suggests that the blockage is occurring beyond the junction where the common canaliculus meets the lacrimal sac or in the nasolacrimal duct itself, preventing the passage of the fluid through the tear drainage system.