Normative Quantitative Values for Dacryoscintigraphy and the Effect of Lid Massage.

Our objectives were to establish normative quantitative values for dacryoscintigraphy in an older population and to evaluate the effect of lid massage. Methods: We conducted a prospective study of 44 eyes of 22 participants aged between 54-90 y that had no symptoms of epiphora and no clinical tear film instability, lid abnormality, lacrimal system impairment, or patent lacrimal duct on syringing. Dacryoscintigraphy was performed and interpreted by a single nuclear medicine physician. The scan protocol involved instillation of 99mTc-pertechnetate in each eye, with a 45-min scan performed with 1-min frames. Lid massage and a sinus clearing maneuver were then performed, followed by a further 45 min of scanning. Results: The mean age of the 22 participants was 71.9 y. Quantitative analysis by half-clearance time (HCT) demonstrated a median presac HCT of 25.5 ± 15.0 min and a whole-eye HCT of 40.0 ± 19.5 min. There was no association between age or sex and HCT. Qualitatively, 29 of 44 eyes (66%) appeared to have at least 1 region of delayed clearance, with improvement noted in 23 after lid massage (79%). Conclusion: We report the quantitative values for dacryoscintigraphy in an asymptomatic older population who had normal findings on lacrimal examination. A high rate of delay in radiotracer transit on qualitative examination suggesting a low specificity. The false-positive rate was significantly improved with the novel approach of adding lid massage, and the significance of this finding merits further research.

Alternative therapies for dry eye disease.

PURPOSE OF REVIEW: Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED. RECENT FINDINGS: Neuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types. SUMMARY: Several alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.

Endonasal endoscopic treatment of recurrent dacryocystitis.

This report assessed clinical conditions leading to recurrent dacryocystitis and success rates of its treatment by endonasal endoscopic dacryocystorhinostomy. Forty-eight patients with recurrent dacryocystitis underwent endonasal endoscopic surgery and were followed up for at least 6 months. High bone windows, small bone window openings, small lacrimal sac stomas, scar tissues, and organic diseases of the nasal cavity led to fistula closure. Out of 48 patients, 45 (93.8%) patients were cured by endonasal endoscopic surgery. Endonasal endoscopic dacryocystorhinostomy is beneficial for recurrent dacryocystitis.

[Digital X-ray examination in diagnosis of lacrimal pathways disorders].

Digital radiological images of normal and patients with lacrimal pathways disorders were analyzed. Potentials of digital X-ray in diagnosis of lacrimal pathways disorders are demonstrated.

The clinical value of dacryoscintigraphy in the selection of surgical approach for patients with functional lacrimal duct obstruction.

PURPOSE: Dacryoscintigraphy is widely known to be an effective modality in diagnosing abnormalities of the lacrimal system that cause epiphora (pathological overflow of tear). However, dacryoscintigraphy rarely serves beyond the simple diagnostic use for lacrimal duct obstruction. In our study, dacryoscintigraphy results of patients with functional lacrimal duct obstruction are newly classified into three types, the effects and prognoses of silicone tube intubation are noted according to each type, and the role of dacryoscintigraphy in determining appropriate surgical approaches is evaluated. METHODS: Subjects were 36 eyes of 29 patients complaining of epiphora who had increased tear meniscus, but showed no sign of obstruction on duct syringing. Impression of functional lacrimal duct obstruction was made through dacryoscintigraphy, and silicone tubes were inserted. RESULTS: Patients were classified according to the results of dacryoscintigraphy; those with delayed secretion in the distal nasolacrimal duct were typed as class I; those with delays in the proximal nasolacrimal duct class II; and delayed secretion from the pre-lacrimal sac to the lacrimal sac as class III. All patients had silicone tube intubations together with selective punctoplasty. Symptomatic improvement was observed in all 6 cases of distal nasolacrimal duct obstruction (100%), 14 of 18 proximal obstruction cases (77.8%), and 8 of 12 pre-lacrimal obstructions (66.7%). CONCLUSIONS: Functional lacrimal duct obstruction is easily diagnosed with dacryoscintigraphy. Furthermore, its may be classified by types of obstruction to predict post-operative results of silicone tube insertion. Cases suspicious of pre-lacrimal sac obstructions in particular may achieve better operative results with adjuvant treatments in addition to silicone tube insertion.

Silicone versus collagen plugs for treating dry eye: results of a prospective randomized trial including lacrimal scintigraphy.

PURPOSE: To compare the short-term efficacy of collagen and silicone plugs for treating dry eye using quantitative lacrimal scintigraphy. DESIGN: Prospective randomized clinical trial. METHODS: In this institutional study, 24 dry eye patients were evaluated in two groups: group I (n = 22 eyes) received collagen plugs and group II (n = 26 eyes) received silicone plugs. Comparisons were made with normal control subjects (n = 22 eyes). Data for the Schirmer I test, tear break-up time, and ocular surface staining with rose bengal dye were recorded before and after punctal occlusion. Lacrimal scintigraphy was performed at each time point, and the time to half maximum activity on the ocular surface (T(1/2)), and the percentage retention of activity on the ocular surface at the end of the dynamic study (RI) were recorded. RESULTS: In both patient groups, Schirmer I results, tear break-up times, and rose bengal staining scores improved significantly after plug insertion. Mean T(1/2) values and RI values increased significantly in both groups (P < .0001 for both). The differences for these values between groups I and II was statistically insignificant (P > .05). CONCLUSIONS: Collagen and silicone plugs both resulted in significant increases in aqueous tear volume, half-life of nuclear material on the ocular surface, and percentage of nuclear material retention. The groups' post-insertion values for all parameters were similar. These results suggest that these two plug types have similar efficacy as treatments for dry eye in the short term. Further studies evaluating long-term results are required.

Computed tomography dacryocystography.

Twenty-one patients with epiphora were examined by conventional dacryocystography, using Lipiodol as a contrast medium, and CT dacryocystography, using a water soluble contrast medium. In the latter, the material was not introduced under pressure but three or four drops were administered, providing a physiological method of investigation. Subsequently, CT dacryocystography provides functional information about lacrimal disorders and is easy to use.

Case report: extravasation of lipiodol--a complication of dacryocystography.

We describe the occurrence of a significant cosmetic blemish in the cheek of a young girl which was caused by extravasation of 'Lipiodol' from the lacrimal canaliculus. Erythema and swelling lasted for several months before resolving completely. This complication has not been reported in the English literature before.

[Causes and incidence of short-life keratitis caused by dacryography. Optimization of protective parameters]. / Cause e incidenze delle cheratopatie fugaci da dacriografia. Ottimizzazione dei parametri protettivi.

This study was aimed at investigating the changes occurring in superficial corneal epithelium (localized or diffuse, dotted or linear) as observed in 300 eyes after macrodacryography with iodate contrast media (iodized oil and water soluble non-ionic agents). In our opinion, the causes of iatrogenic short-life keratitis are: needle injury, the deposition of iodate contrast medium on the cornea and the reduction of palpebral winking, favoring dry eye, due to superficial anesthesia. The pharmacologic protection of the cornea by means of high-viscosity drugs allows both the number and the degree of keratitis to be markedly reduced. Therefore, contrast media must be chosen on the basis of anamnestic and clinical data, as well as of patient's symptoms, focusing mainly on the characteristics of the various agents--i.e., density, concentration, viscosity.

Dacryocystography: comparison of water-soluble and oil-based contrast agents.

Dacryocystography has been widely used in the assessment of the nasolacrimal duct system, particularly in patients with epiphora. Our study was undertaken to evaluate image quality and level of patient discomfort during examinations with water-soluble contrast agents (iohexol [Omnipaque 240], iopamidol [Isovue 200 and 300], and 52.7% diatrizoate meglumine and 26.9% iodipamide meglumine [Sinografin]) compared with the iodized oil-based contrast agent Lipiodol. Fifty-five dacryocystograms were obtained from 41 consecutive patients. The procedure was performed first with a water-soluble contrast agent, then repeated with Lipiodol. A distention technique was used with conventional radiography. Patients were asked to evaluate their level of discomfort (none, mild, moderate, severe). The images were evaluated separately by two radiologists, blinded to which water-soluble agent was employed, and the images were graded on a five-point scale. Images obtained with Lipiodol were significantly better than those with other agents (P less than .02), and image quality deteriorated as iodine concentration decreased. Use of Isovue 300 and Sinografin produced significantly more patient discomfort (P less than .03) than the use of other agents. The authors conclude that, in most instances, Lipiodol is the contrast agent of choice with regard to both highest level of patient comfort and greatest conventional radiographic image quality among the agents compared.

[Does a iatrogenic damage caused by dacryography exist?]. / Esistono danni iatrogeni da dacriografia?

This study was aimed at investigating the changes in corneal epithelium caused by dacryocystography. Such changes can be either chemical--from iodate contrast media (iodized oil and water-soluble non-ionic cm)--or physical--from needle or catheter. Twenty-five patients (50 eyes) were studied using BUT, Schirmer tests, biomicroscopy, and pachymetry. Follow-ups immediately after dacryocystography demonstrated superficial keratitis, which was less severe with water-soluble non-ionic cm. Such lesions were hardly ever observed in patients who had been treated with dacriosol ointment on the cornea just before the X-ray exam. Follow-ups at 24 hours showed the superficial keratitis to have disappeared in all patients, independent of the kind of cm employed and of the ophthalmic ointment applied to the cornea.

Radiography in functional lacrimal testing.

A functional study of the lacrimal drainage apparatus was made in 25 patients. Angiographin was instilled into the conjunctival sac and serial radiographs were taken. The films were interpreted in conjunction with the intubation macro-dacryocystograms. Although this is a useful procedure, the use of angiographin compares unfavourably with ultra-fluid Lipiodol in a similar procedure.