Lacrimal Passage Obstruction and Cataract Surgery: A Scoping Review and Recommendations for General Ophthalmology Practice

Lacrimal passage obstruction is common in patients with significant cataract awaiting surgery and may increase the risk of post-perative endophthalmitis. A PubMed-based search was conducted for a scoping review of the published evidence. In total, 17 articles were included. Overall, there is a dearth of scientific evidence on this subject, and the available studies are of poor quality. Nevertheless, some recommendations can be made. Evidence supports the recommendation that a routine lacrimal screening protocol should be performed before cataract surgery to decrease postoperative risk. Both lacrimal irrigation and regurgitation on pressure over the lacrimal sac (ROPLAS), or the micro-reflux test combined with a history of epiphora, have good sensitivity and excellent specificity for diagnosing nasolacrimal duct obstruction. An interval of about four weeks between dacryocystorhinostomy (DCR) and cataract surgery appears adequate for normalization of bacterial flora. Although evidence is limited and of low quality, routine lacrimal screening and appropriate timing after DCR seem advisable in patients planned for cataract surgery.