Question

A 60 year old man presented with watering from his left eye since one year. Syringing revealed a patent drainage system. Rest of the ocular examination was normal. A provisional diagnosis of lacrimal pump failure was made. Confirmation of this diagnosis would be:

• A. Dacryoscintigraphy
• B. Dacryocystography
• C. Pressure syringing
• D. Canaliculus irrigation test

Hint:

Patent syringing rules out a block, so the next test must check tear pump function, not anatomy.

Answer 1

The Correct Option is A

Step 1: Understand what a patent syringing test means.
Syringing pushes saline through the tear drainage channel under pressure. If the fluid reaches the nose freely, the channel is anatomically open, that is, patent. This patient's syringing is patent, so there is no physical block in the tear drainage pathway.

Step 2: Understand what lacrimal pump failure means.
Tears normally move from the eye into the nose with help from the blinking action of the eyelid muscles, which act like a pump on the tear sac. In lacrimal pump failure, this pumping action is weak, so tears sit on the eye and overflow even though the drainage channel itself is open. This is a functional problem, not a blockage.

Step 3: Match the diagnosis to the right test.
Since the channel is already known to be open, the next test must check function, not anatomy. Dacryoscintigraphy uses a small radioactive tracer drop placed on the eye and follows its natural movement into the nose over time under a gamma camera. It shows how well the tear pump is actually working under normal blinking conditions, so it is the confirmatory test for lacrimal pump failure.

Step 4: Rule out the other options.
Dacryocystography injects dye and takes X-rays to show the shape and any narrowing of the drainage channel, which is an anatomical test, and this patient's anatomy is already shown to be open. Pressure syringing and the canaliculus irrigation test both again test whether fluid can be forced through under pressure, which only repeats what plain syringing already showed and does not test the natural pumping action.

Step 5: Final Answer.
Dacryoscintigraphy is the confirmatory test for lacrimal pump failure with a patent drainage system. \[ \boxed{\text{Dacryoscintigraphy}} \]