title: The Micro-Reflux Test: a new test to evaluate nasolacrimal duct obstruction.
abstract: OBJECTIVE
  The authors describe a new and simple procedure, the Micro-Reflux Test (MRT), to screen for primary acquired nasolacrimal duct obstruction (PANDO). This study sought to determine the reliability of this new test in the diagnosis of complete nasolacrimal duct obstruction.
  
  
  METHODS
  A nonrandomized, prospective, self-controlled, comparative case series.
  
  
  METHODS
  Two hundred eyes of 100 patients with documented unilateral complete PANDO were examined.
  
  
  METHODS
  The MRT was performed by a masked examiner on both eyes of each patient. Two drops of 0.25% sodium fluorescein dye were instilled in the inferior cul-de-sac and the patient made to blink five times to activate the lacrimal pump mechanism. Excess fluorescein dye was blotted away using tissue paper. The patient was positioned at the slit lamp, and observation of the inferior punctum with the cobalt blue filter was done using 5x magnification. The tissue overlying the lacrimal sac was massaged in a counterclockwise direction with moderate pressure using the index finger. The test was considered positive if there was continued observed reflux of fluorescein-stained tears from the inferior punctum after the initial counterclockwise massage to empty the inferior canaliculus. The validity of the MRT was measured by sensitivity and specificity as well as positive- and negative-predictive values.
  
  
  METHODS
  The MRT was considered positive if there was continued reflux of fluorescein-stained tears from the inferior punctum after the initial digital massage to empty the dye from the inferior canaliculus.
  
  
  RESULTS
  The MRT used for the evaluation of complete PANDO has a sensitivity of 97% and a specificity of 95%. It has a positive-predictive value of 95% and a negative-predictive value of 97%.
  
  
  CONCLUSIONS
  The MRT is a reliable screening test for presence of complete nasolacrimal duct obstruction.
authors.affiliation: Department of Ophthalmology, John A. Burns School of Medicine, University of Hawaii-St. Francis Medical Center, Honolulu, USA. jordegcam@msn.com
authors.forename: J G
authors.initials: JG
authors.lastname: Camara
authors.forename: M D
authors.initials: MD
authors.lastname: Santiago
authors.forename: R E
authors.initials: RE
authors.lastname: Rodriguez
authors.forename: R A
authors.initials: RA
authors.lastname: Medalle
authors.forename: D A
authors.initials: DA
authors.lastname: Young
authors.forename: N H
authors.initials: NH
authors.lastname: Atebara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003941:Diagnostic Techniques, Ophthalmological; D005188:False Negative Reactions; D005260:Female; D019793:Fluorescein / Q000378:metabolism; D006801:Humans; D007223:Infant; D007765:Lacrimal Apparatus / Q000378:metabolism; D007767:Lacrimal Duct Obstruction / Q000175:diagnosis* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000378:metabolism / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013666:Tears / Q000378:metabolism
chemical_list: D019793:Fluorescein