Lacrimal Testing: Age as a Factor in Jones Testing

Abstract

A modified Jones test is used to assess whether lacrimal transit time varies with age. The right eyes of 101 control subjects and 18 patients suspected of having lacrimal system abnormalities were tested with one drop of 2% sodium fluorescein solution. A cotton applicator was placed in the nose next to the inferior turbinate and participants were asked to lean forward. Dye passage was assessed every 3 minutes for 24 minutes. The results were assessed by age. In control subjects, there seemed to be a natural break in the distribution of the data at the age of 45 to 50 years. In control subjects younger than 45 years of age, 10/11 (91%) passed dye in 6 minutes or less (median = 3 minutes), whereas in those 45 years of age and older, 79/90 (84%) passed dye in 12 minutes or less (median = 6 minutes). The results were statistically significant (P = 0.0091). In contrast, patients with symptoms of epiphora due to a nasolacrimal duct obstruction had lacrimal transit times in excess of the above limits. This study confirms that the lacrimal transit time slows with age. The modification of the Jones test presented here requires a cutoff of 6 minutes in patients younger than 45 years of age and 12 minutes in patients 45 years of age and older.