From the Research
ROPLAS and lacrimal syringing are essential diagnostic procedures that should be performed before cataract surgery to assess lacrimal drainage system patency, as recommended by the most recent study 1.
Procedure Overview
The procedure for ROPLAS involves placing a finger over the lacrimal sac area and applying gentle pressure while observing the puncta for any regurgitation of fluid or mucus, which would indicate obstruction.
- Lacrimal syringing involves irrigating the lacrimal drainage system with saline solution to confirm patency.
- First, instill topical anesthetic drops (0.5% proparacaine or 4% lidocaine) into the eye.
- Then dilate the punctum with a punctum dilator if needed.
- Insert a lacrimal cannula attached to a 2-5ml syringe filled with normal saline into the lower punctum, directing it medially and slightly downward.
- Gently inject the saline while observing for fluid passage into the nose or throat (patency), reflux through the same punctum (partial obstruction), or reflux through the opposite punctum (common canalicular obstruction).
Importance of Preoperative Screening
These procedures are crucial before cataract surgery because lacrimal drainage obstruction can increase the risk of postoperative endophthalmitis by allowing bacteria to accumulate on the ocular surface, as highlighted in a study from 2.
- If obstruction is detected, it should be addressed before proceeding with cataract surgery, either through conservative management or surgical intervention like dacryocystorhinostomy, depending on the severity and location of the obstruction.
- A study from 3 also emphasizes the importance of diagnosing and managing nasolacrimal duct obstruction concomitant to cataract, to minimize the risk of postoperative endophthalmitis.
Diagnostic Accuracy
The diagnostic accuracy of ROPLAS versus lacrimal irrigation for screening nasolacrimal duct obstruction was evaluated in a study from 1, which found that ROPLAS had a low sensitivity and positive predictive value compared to lacrimal irrigation.
- Therefore, both ROPLAS and lacrimal syringing should be performed as part of the routine preoperative workup prior to cataract surgery 1.
- This approach ensures that any potential lacrimal drainage obstruction is identified and addressed, reducing the risk of postoperative complications.