"A Comprehensive Journey of A Primary Acquired Nasolacrimal Duct Obstruction (PANDO)" presented by Dr. Mohsen B Kashkouli, MD

Learning Objectives: 

• Identify the clinical features and step wise diagnostic tools used to differentiate primary acquired NLDO (PANDO) from other causes of epiphora.
• Describe the convention external dacryocystorhinostomy (Ext-DCR), 5-mm Incision Ext-DCR, and endoscopic DCR for management of PANDO.
• Indicate a less invasive diagnostic approach to post DCR epiphora. 

Pre-Presentation Questions: 

1. A 55-year-old woman presents with chronic tearing. If required, which one is the best order of performing the following tests?
   1. Regurgitation, irrigation, Lacrimal Scintigraphy
   2. Regurgitation, Lacrimal Scintigraphy, Irrigation
   3. Irrigation, Regurgitation, Lacrimal Scintigraphy
   4. Irrigation, Lacrimal Scintigraphy, Regurgitation
2. A 62-year-old woman presents with chronic tearing and recurrent medial canthal discharge for the last 6 months. There is an elevated mass under the skin at the medial canthal angle extending above and below the medial canthus. Pressure on the lacrimal sac showed positive reflux (Regurgitation) of the mucoid discharge from the puncta. What is the next best management step?
   1. Lacrimal Irrigation Test
   2. Dacryoscintigraphy
   3. Orbital CT Scan
   4. Schedule for Dacryocystorhinostomy
3. A 55-year-old woman who had a prior DCR procedure 6 months ago presents with persistent tearing. If required, which one is the best order of performing the following tests? (FDDT: Fluorescein Dye Disappearance Test, ABT: Air Bubble Test)
   1. FDDT, Irrigation, Regurgitation, ABT
   2. Regurgitation, FDDT, ABT, Irrigation
   3. Irrigation, ABT, Regurgitation, FDDT
   4. ABT, Irrigation, FDDT, Regurgitation