Page 124 - NAME OF CONDITION: REFRACTIVE ERRORS

External examination:

The following points should be looked for:

1. Increased tear lake
2. Visible or palpable enlargement of the lacrimal sac
3. Discharge which at times may be copious.
4. Regurgitation on pressure over the lacrimal sac or ROPLAS test is a simple
confirmatory test, which if positive is diagnostic of nasolacrimal duct
obstruction and usually does not require further investigations.
5. Abnormalities of skin like crusting or eczematous lesions suggest chronic
changes caused by watering. Skin may also show a lacrimal fistula or a scar

of past acute dacryocystitis or lacrimal abscess.

Slit-lamp Biomicroscopy:
Should include evaluation of the following:
1. Increased tear film height.
2. Matted lashes.
3. Lacrimal puncta and canaliculi for pouting and discharge
4. Variable types of discharge like clear, mucoid or muco-purulent.
5. Micro regurgitation with ROPLAS test as described earlier can be useful in

cases where there is no frank regurgitation.
6. Conjunctival congestion

Fluorescein Dye Disappearance test
This is a very useful physiological test which is based on the principle of evaluation of
residual fluorescien in the eye following instillation of one drop of fluorescein in
unanesthetized conjunctival sac. This is a useful functional test specifically in children
as it is easy to obtain results.

STANDARD PROCEDURE:
1. One drop of 1-2% fluorescein is instilled into the lower fornix of each eye.
2. After 5 minutes the thickness of the fluorescent tear meniscus is measured with
the help of cobalt blue filter.
3. Children should be held upright during the test.
4. The tears normally drain down in 5 minutes. The test is positive if residual
fluorescein is present.
5. The residual fluorescein is graded as Grade 0- No fluorescence , Grade 1- Thin
strip of fluorescence, Grade 2- Between grade 1 and 3, and Grade 3- Wide,
brightly fluorescence strip.

Diagnostic Probing and Syringing
This is a very simple clinical method which when employed appropriately give useful
clues that helps the physician in knowing the presence, location and the form of
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