Agreement Between ROPLAS and Syringing Test for Dacryocystitis in Symptomatic Eyes Before Eye Surgery
ROPLAS (Regurgitation on Pressure over the Lacrimal Sac) demonstrates excellent agreement with syringing tests for diagnosing dacryocystitis, with high sensitivity (93.2%) and specificity (99.3%), making it a reliable alternative to syringing before eye surgery. 1
Diagnostic Performance Comparison
The evidence strongly supports ROPLAS as a reliable alternative to syringing for detecting dacryocystitis:
- ROPLAS demonstrates 93.2% sensitivity and 99.3% specificity compared to syringing 1
- With a 6.6% prevalence of chronic dacryocystitis in cataract surgery populations, ROPLAS has a negative predictive value of 99.5% 1
- When ROPLAS is positive (regurgitation is present), the high specificity confirms chronic dacryocystitis 1
Clinical Outcomes Comparison
The most recent evidence (2021) directly comparing both methods shows:
- Post-cataract endophthalmitis (PCE) rates were statistically similar between patients screened with syringing (0.039%) versus ROPLAS (0.051%), p=0.517 2
- No significant differences were found in:
- Grade of anterior chamber cellular reaction (p=0.675)
- Hypopyon presence (p=0.738)
- Vitreous haze (p=0.664)
- Visual outcomes (presenting and final visual acuity) 2
Practical Implications for Pre-Surgical Screening
Based on the evidence, ROPLAS offers several advantages:
- Non-invasive compared to syringing
- Excellent diagnostic performance
- Comparable clinical outcomes in preventing post-surgical infections
- May be particularly valuable in settings where reducing aerosol-generating procedures is important (as demonstrated during COVID-19) 2
When to Consider Syringing Despite Negative ROPLAS
While ROPLAS is generally reliable, syringing may still be indicated in specific scenarios:
- When ROPLAS findings are equivocal
- When clinical suspicion for dacryocystitis remains high despite negative ROPLAS
- In patients with history of lacrimal system abnormalities 1
Common Pitfalls and Caveats
- Proper ROPLAS technique is essential: Ensure adequate pressure is applied over the lacrimal sac area
- False negatives can occur: Though rare (given 93.2% sensitivity), they are possible, especially with partial obstructions
- Consider patient factors: Previous lacrimal surgery, facial trauma, or congenital anomalies may affect test reliability
- Rose Bengal vs. Lissamine Green: While the question mentions ROPLAS with Rose Bengal and Lissamine Green staining, the evidence specifically addresses ROPLAS as a physical test (regurgitation on pressure) without these stains 1, 2. The other studies discuss Rose Bengal and Lissamine Green for ocular surface evaluation 3, 4, 5, not for lacrimal system patency assessment.
ROPLAS represents a highly effective screening tool that can potentially replace routine pre-surgical syringing in most cases, maintaining similar safety profiles while reducing invasiveness and resource utilization.