AN EASY-TO-USE SCREENING TOOL FOR EPIPHORA BEFORE CATARACT SURGERY: MUNK’S SCALE

Cataract surgeons should always be aware of the lacrimal system disorders preoperatively. For instance, Chronic dacryocystitis (CDC), a common reason of epihora, is a misdiagnosed and overlooked risk factor for post-cataract surgery endophtalmitis. Every country has their own screening tools for epiphora and CDC. In India all cataract patients are routinely undergo syringing before surgery to rule out CDC. However, in Turkey there is no routine screening method for epiphora before a cataract surgery. Hence, this study aimed to find out the usefulness of Munk’s scale in epiphora screening before a routine cataract surgery.

A prospective study was held in the department of Cataract Refractive Surgery Clinic at the Kayseri City Hospital between 01.01.2022 and 01.08.2022

In this study Munk’s scale is performed on 300 consecutive cataract patients. Briefly, the Munk’s scale is an easily performed questionnaire used for epihora evaluation. The scale consists of 6 grades of the epiphora evaluated by requiring dabbing times in a day:0 is for no epihora; 1 is for less than twice a day, 2 is for 2-4 times, 3 is for 5-10 times a day, 4 is for more than 10 times a day, 5 is for constant epihora. After the questionnaire all patients were underwent a syringing of the nasolacrimal ductus (NLD, test was + for patent NLD).Age, gender, laterality of the eye, Munk’s scale grade and  syringing test results were recorded.

The mean age of the patients were 68.11 ± 11 (24-92) years. There were more female patients than males (54%-46%). The right eyes were more than left eyes (53%- 47%). Munk’s scale was 0 in the majority of the patients; in 190 patients (63.3%). The score was 1 in 50 patients (16.7%), 2 in 32 (10.7%), 3 in 17 (5.7%), 4 in 8(2.7%) and 5 in only 3 patients (1%). The syringing test was positive in 296 (98.7%) patients. The punctums were normal in 292 patients (97.3%). The syringing was negative in 2 patients with a Munk’s scale of 5, in 1 patient with a Munk’s scale of 3 and in 1 patient with a Munk’s scale of 4. The - syringing test was found to be more in patients with higher Munk’s scale (p<0.001). There was a positive correlation with the negative syringing and Munk’s scale (r=0.211, p<0.001).

The study showed that a majority of included patients had a lower grade of Munk’s scale. The scale was found to be positively correlated with the negative syringing test. The scale is seem to be a cost-effective method in screening patients for epiphora especially screening the cataract patients preoperatively. This study should be considered as a pilot study and needs to be validated in a larger patient group.