Lacrimal gland test

1-Regurgitation test(regurge test)

Aim: detects obstruction below the lacrimal sac(mostly in NLD)

Steps:

1-Press just below the medial palpebral ligament(MPL) by the little finger or by a glass rod covered by a piece of cotton(anatomical site of lacromal sac).

*MPL becomes more exposed by outward traction of the skin at the lateral canthus.

*It is better to use the right little finger to the left sac & the reverse

2-Observe regurgitation of any discharge(e.g. watery,mucus,pus) from the lower or upper punctum= +ve regurge test . If no regurgitation= -ve regurge test

Results:

*+ve regurge: means obstruction below the lacrimal sac

*-ve regurge : means patent lacrimal passages

Oral questions:

*Site of lacrimal sac

*Causes of +ve regurge test(e.g. dacryocystitis)

*When regurge test becomes –ve with dacryocystitis

*Disadvantages of regurge test:

Not localize the site of obstruction accurately

Not differentiate between partial & complete obstruction

*Investigations of watery eye

*Dacryocystitis

 

2-Palpation of lacrimal glands:

Aim: to detect enlargement of the lacrimal glands(Normally lacrimal gland is not palpable)

Steps:

1-The patient is sitting & the examiner is standing to the patient's side (same side of the tested gland)

2-Ask the patient to look down & nasally.

3-Try to palpate the lacrimal gland by introducing your little finger (with its anterior surface upwards)between the globe & the upper outer part of the orbital margin. Use the right little finger for the right gland & the reverse.

Results:

*If palpableàenlargement of the lacrimal gland

*If not palpable: Normal lacrimal gland

Oral questions:

*Site of lacrimal glands

*Causes of lacrimal gland enlargement (unilateral & bilateral)

*What type of proptosis induced by lacrimal gland enlargement

*Approach used to remove lacrimal gland tumours.

*Is removal of lacrimal glands must induce dry eye.