Which testing step is included in NLDO evaluation?

• A. Palpating the lacrimal sac for mucoid discharge and performing Jones I and II tests.
• B. Color vision testing alone.
• C. Slit-lamp exam without lacrimal testing.
• D. Fundus examination only.

Answer: (A)

Testing of NLDO evaluation centers on the tear drainage system. Palpating the lacrimal sac to feel for distension or mucoid discharge helps identify outlet issues within the sac area. The Jones tests, particularly Jones I, assess whether fluorescein introduced into the eye makes it to the nasal cavity, indicating that tear drainage is at least anatomically patent, while Jones II adds irrigation to distinguish proximal versus distal or functional problems. Together, probing the lacrimal sac and performing Jones I and II tests directly evaluate the lacrimal drainage pathway, which is central to NLDO assessment.

Color vision testing alone, slit-lamp exam without lacrimal testing, or fundus examination without focusing on tear drainage do not specifically evaluate the nasolacrimal duct system, so they’re not the testing steps used for NLDO evaluation.