A 45-year-old woman presents with recurrent unilateral medial canthal swelling and epiphora. Pressure on the lacrimal sac produces mucopurulent reflux through the punctum. The Jones primary dye test is negative (no dye in the nasal cavity at 5 minutes) but Jones II test is positive (dye recovered in recovered irrigant). This pattern suggests:

• A Partial (incomplete) nasolacrimal duct obstruction ✓
• B Punctal stenosis
• C Functional epiphora with patent nasolacrimal duct
• D Complete nasolacrimal duct obstruction requiring dacryocystorhinostomy

Explanation

Jones I (primary dye test): fluorescein instilled in conjunctival sac; positive if dye recovered from nose (patent, functional system). Jones II: irrigation after failed Jones I; if dye is recovered in the irrigant from the nose, it means the dye reached the sac but could not pass the duct spontaneously — indicating partial NLD obstruction. Complete NLD obstruction would not allow dye to reach the nose even with irrigation. Punctal stenosis would cause failure of dye entry into the canaliculus, and Jones II would also be negative.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.