Purpose To assess the results of our protocol of repeated probing for the treatment of congenital nasolacrimal duct obstruction in various presentations. METHODS A total of 1600 patients (1748 eyes) with congenital dacryocystitis (850 boys, 750 girls; age range, 1 month to 48 months [mean 16.54 ± 12.21 months]) were included. Diagnosis was confirmed by history of tearing, crusting of lids, and a boggy swelling over inner canthal region, which on pressure ejected mucopurulent discharge through punctum. Antibiotic eye drops were instilled five times a day for a week in affected eyes after the mother pressed the sac area and cleaned the discharge. The cases that were not relieved were subjected to sequential probing dilating with an increasing diameter probe repeated in failed cases second and third times at 1-week interval. Results Medical treatment was effective in only 60 eyes (3.43%). Probing and syringing achieved successful results in 790 eyes (100%) aged 1 month to 12 months; 330 eyes (99.40%) aged 12 months to 18 months; 200 eyes (98%) aged 18 months to 24 months; 150 eyes (95.24%) aged 24 months to 36 months; and 158 eyes (89.87%) aged 36 months to 48 months. The cure rate with first probing was 98.10%, second probing was 99.64%, and third probing was 100%. CONCLUSIONS Our protocol of medical regime and early probing repeated two to three times was very effective in the treatment of nasolacrimal duct obstruction at all ages. A second and third probing was recommended after 1 week of the first probing with successful results if first probing failed.

Purpose To report reflex epiphora in patients with dry eye symptoms and describe the role of variable time Schirmer-1 test. Methods The study was conducted in 16 consecutive dry eye patients (32 eyes), nine male and seven female, aged 16 to 73 years (mean 48.56±16.68 years), presenting with reflex epiphora. Each eye was subjected to Schirmer-1 test and the time elapsed in total wetting of the 35 mm strip from its placement into the conjunctiva was noted and test was graded. This was compared with symptomatology, closed chamber infrared thermometry, humidity, fluorescein tear break-up time (FTBUT), fluorescein stain test, and Lissamine green stain. Results Schirmer-1 test differentiated reflex epiphora in dry eye patients into groups 0 to 4 based on time it took to wet the 35 mm strip (Group 0 = ≤5 min; Group 1 = ≤2 min; Group 2 = ≤1.5 min; Group 3= ≤1 min; Group 4 = ≤1/2 min). The score was −0.04 in 8 eyes, −0.03 in 10 eyes, −0.02 in 2 eyes, −0.01 in 6 eyes, and 0.00 in 6 eyes in Groups 4, 3, 2, 1, and 0, respectively. Reflex epiphora had a statistically significant correlation to the symptomatology (p<0.001), lissamine green staining (p<0.001), closed chamber humidity difference (p<0.001), and FTBUT score (p=0.001). Fluorescein stain test and difference in infrared thermometry did not show any correlation. A statistically significant correlation existed between severe and mild to moderate reflex epiphora (p=0.002). However, the two groups separately failed to show any statistically significant relationship with the symptomatology (p=0.16), Lissamine green (p=0.69), humidity difference from close to open eye position (p=0.17), and FTBUT (p=0.25). Thermometry and fluorescein stain test showed no relationship. Conclusions Schirmer-1 test with variable time quantifies reflex epiphora in dry eye patients, which was significantly related to the other tear function tests.