From the Guidelines
The correlation between ROPLAS and lacrimal syringing in symptomatic adults before cataract surgery is crucial for assessing nasolacrimal duct obstruction, with both tests providing complementary information to guide surgical decisions and minimize postoperative complications, such as endophthalmitis 1.
Key Considerations
- The provided evidence focuses on managing dry eye disease before, during, and after cataract surgery, highlighting the importance of timely diagnosis and treatment of ocular surface disorders to ensure positive surgical outcomes 1.
- While the evidence does not directly address the correlation between ROPLAS and lacrimal syringing, it emphasizes the need for thorough preoperative assessment, including diagnostic testing for conditions that could impact surgical success, such as dry eye disease and nasolacrimal duct obstruction.
- Identifying and addressing nasolacrimal duct obstruction before cataract surgery is vital to prevent postoperative complications, and both ROPLAS and lacrimal syringing play roles in this assessment, with ROPLAS serving as a useful initial screening tool and lacrimal syringing as the gold standard for definitive diagnosis.
Clinical Implications
- Symptomatic adults presenting with epiphora before cataract surgery should undergo both ROPLAS and lacrimal syringing to accurately assess the patency of the nasolacrimal drainage system.
- If nasolacrimal duct obstruction is confirmed, surgical options include postponing cataract surgery until the obstruction is addressed, performing dacryocystorhinostomy before cataract surgery, or using prophylactic antibiotics and careful surgical technique if surgery cannot be delayed.
- The sensitivity of ROPLAS, approximately 70-80% compared to syringing, makes it a valuable but not perfect screening tool that should be complemented by syringing in symptomatic patients to ensure comprehensive assessment and appropriate management.
From the Research
Correlation of ROPLAS and Lacrimal Syringing
- There is no direct correlation between ROPLAS and lacrimal syringing in the provided studies, as ROPLAS is not mentioned in any of the studies.
- However, lacrimal syringing is discussed as a method for screening nasolacrimal duct obstruction before cataract surgery 2, 3, 4.
- Nasolacrimal duct obstruction is a significant risk factor for postoperative endophthalmitis, and routine screening for symptoms and examination of the lacrimal system is recommended prior to cataract surgery 3, 4.
Lacrimal Syringing in Symptomatic Adults
- Lacrimal syringing is an invasive procedure that can rule out nasolacrimal duct obstructions, but it also risks iatrogenic injury to the lacrimal drainage system (LDS) 2.
- A practice model for lacrimal syringing, called "SYRI", has been developed to improve proficiency in syringing and to enhance the understanding of canalicular and NLD blocks 2.
- The model presents a commendable representation of the NLD system, but it has some limitations, such as the absence of eyelid margins and the inability to replicate the lateral pulling of the eyelid 2.
Preoperative Care for Cataract Surgery
- Preoperative care for cataract surgery includes screening for nasolacrimal duct obstruction, which can be done using lacrimal sac expression test or irrigation of the tear pathways 4.
- Most surgeons indicate that they usually perform lacrimal surgery prior to intraocular surgery, waiting for 4 to 6 weeks to proceed with the cataract surgery 4.
- The procedure of choice for treating nasolacrimal duct obstruction prior to cataract surgery is dacryocystorhinostomy 4.