In the Jones dye test for nasolacrimal drainage assessment, Jones I test is positive when:

• A No fluorescein in the nose after blowing, but recovery on irrigation suggests partial canalicular or valve obstruction
• B Clear fluid irrigated from the opposite punctum confirms complete NLD obstruction
• C Fluorescein recovered in the nose after blowing confirms patent primary secretory and drainage system ✓
• D Delayed recovery of dye beyond 5 minutes indicates dacryostenosis

Explanation

Jones I test: fluorescein dye is instilled in the conjunctival sac, and a cotton-tipped applicator placed beneath the inferior turbinate in the nose. Recovery of fluorescein-stained dye from the nose within 5 minutes indicates a positive Jones I test, confirming the lacrimal drainage system is patent under physiological conditions (capillary action and lacrimal pump). A negative Jones I (no dye in nose) suggests obstruction or lacrimal pump failure. Jones II test then proceeds: the cul-de-sac is irrigated with saline — if dye-stained fluid emerges from the nose, this confirms partial obstruction (Jones II positive); if only clear fluid, this indicates obstruction is at or proximal to the lacrimal sac. Complete Jones II negativity points to canalicular obstruction.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.