Watery Eyes (Epiphora): Diagnostic Tests

Obligatory medical device diagnostics.

  • Slit-lamp examination (slit-lamp microscope; viewing of the eyeball under appropriate illumination and high magnification) [for findings, see “Physical examination”]
  • Schirmer test (tear secretion test): measurement of the amount of tear production; for this purpose, a 5 mm wide and 35 mm long filter paper strip (litmus paper) is inserted into the outer corner of the eyelid in the conjunctival sac and the wetting is measured; after 5 minutes, the distance is read off that the tear fluid has traveled in the paper strip) – to check the amount of tears [values > 10 mm are the normal finding; evaporative ocular dryness as the cause of tear flow > 25 mm]
  • Tear film break up time (TFBUT); also BUT after break-up time) – measure of tear film stability; for this purpose, the tear film is stained with fluorescein; then the tear film is observed through the slit lamp and the time is measured simultaneously. In this way, it is possible to see when the tear film breaks up. The normal time is between 20-30 seconds in the healthy eye.
  • Examination of tear drainage by flushing the nasolacrimal duct (TNW) by conjunctival dye test and the Jones dye test.
    • Conjunctival dye test to check spontaneous outflowPerformance: the tear fluid is stained by dropping a dye solution (e.g., silver protein acetyltannate eye drops, 5%) into the conjunctival sac. The time required for removal of the dye is then determined. Normal finding: after about 2 minutes, the conjunctival sac is completely decolorized.Pathological finding: there is no reduction in the amount of dye in the conjunctival sac → mechanical stenosis; after excluding the same, an absolute functional stenosis is to be assumed.
    • Dye test according to Jones; a distinction is made between a primary and a secondary dye test
      • Primary dye test (synonym: nasal dye test)Procedure: dropping a dye solution into the conjunctival sac and detecting the fluorescein dye solution in the nasal cavity after the test time of 5 minutes has elapsedNormal finding: tear drainage into the nose.
      • Secondary dye testPrerequisite: flushability of the draining tear ductsPerformance: cleaning of the conjunctival sac from dye residues; tear duct flushing with clear saline solution with the head tilted forward so that the flushing fluid can run out of the nose.Normal finding: leakage of dyed flushing fluid → absolute functional presacral stenosis (constrictions) is excluded.

Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.