Sensitivity of ROPLAS Compared to Syringing for Ear Wax Removal
ROPLAS (Regurgitation on Pressure over the Lacrimal Sac) has a high sensitivity of 93.2% and specificity of 99.3% compared to syringing for detecting nasolacrimal duct obstruction, making it an excellent screening alternative to syringing with comparable clinical outcomes. 1
Comparison of ROPLAS vs. Syringing
Diagnostic Performance
- ROPLAS has demonstrated excellent diagnostic performance with:
- Sensitivity: 93.2%
- Specificity: 99.3%
- Negative predictive value: 99.5% (based on 6.6% prevalence of chronic dacryocystitis) 1
Clinical Outcomes
- A large retrospective comparative analysis (87,144 eyes) showed:
- Post-cataract endophthalmitis rates were statistically equivalent between syringing (0.039%) and ROPLAS (0.051%) groups (p=0.517)
- No significant differences in clinical presentation, microbiological profiles, or visual outcomes between the two screening methods 2
Clinical Application Algorithm
First-line screening: Perform ROPLAS test
- Apply gentle pressure over the lacrimal sac area
- Observe for regurgitation of material
Interpretation:
- Positive ROPLAS: High specificity confirms chronic dacryocystitis
- Negative ROPLAS: High negative predictive value (99.5%) effectively rules out obstruction
When to proceed to syringing:
- Only when ROPLAS findings are equivocal
- When index of suspicion remains high despite negative ROPLAS
- When additional confirmation is needed for surgical planning
Important Considerations
Advantages of ROPLAS over Syringing
- Non-invasive procedure
- Reduced risk of complications
- No need for specialized equipment
- Can be performed quickly in an outpatient setting
- Avoids potential aerosol generation (particularly important during infectious disease outbreaks) 2
Limitations
- Small percentage of false negatives (approximately 6.8%) 1
- May require clinical experience for proper technique and interpretation
Clinical Pearls and Pitfalls
- Pearl: ROPLAS is particularly valuable as a screening tool in high-volume settings where efficiency is important
- Pitfall: Relying solely on patient history without performing either ROPLAS or syringing may miss asymptomatic nasolacrimal duct obstruction
- Pearl: The high negative predictive value means that when ROPLAS is negative, preoperative syringing is generally unnecessary 1
Note: The evidence provided primarily addresses ROPLAS versus syringing for detecting nasolacrimal duct obstruction rather than ear wax removal specifically. The clinical guidelines for cerumen impaction 3 focus on various methods of ear wax removal including irrigation, cerumenolytics, and manual removal, but do not specifically compare ROPLAS to syringing for this purpose.