Comparing the diagnostic accuracy of MR dacryocystography (MRD) and dacryoscintigraphy (DSG) in NLDO-related acquired epiphora.

PROPOSE: This study aimed to compare the diagnostic accuracy of MR dacryocystography (MRD) and dacryoscintigraphy (DSG) in the diagnosis of acquired epiphora related to NLDO. A total of 15 patients with acquired epiphora and suspected NLDO were included in this study. METHODS: All patients underwent MRD and DSG examinations. MRD was performed using a 3-Tesla magnetic resonance imaging (MRI) scanner, while DSG involved injection of a radiotracer into the lacrimal drainage system followed by DSG. The results of both imaging methods were compared with the reference standard that was a combination of clinical examination findings and surgical exploration. RESULTS: The results of this study showed that no abnormal findings were observed in MR-DCG in patients before the Valsalva maneuver. However, after the Valsalva maneuver, stenosis/obstruction at the canal surface was observed in all 15 patients diagnosed by DSG, giving a sensitivity of 100% for canal stenosis. Moreover, the results revealed that among these 15 patients, 9 showed stenosis or simultaneous obstruction at the level of the canal and lacrimal sac, but MR-DCG showed these lesions in only 9 patients, giving a sensitivity of 60%. The specificity of MRD and DSG were 85% and 76.7%, respectively. There was a statistically significant difference in the sensitivity of MRD and DSG (p < 0.05). CONCLUSION: This study demonstrated that MRD has a higher diagnostic accuracy in the diagnosis of acquired epiphora associated with NLDO compared to DSG. MRD showed significantly higher sensitivity and specificity than DSG. Therefore, MRD can be considered as the preferred imaging modality in the diagnosis of acquired epiphora due to NLDO. By accurately identifying the underlying cause of NLDO, MRD can help determine the most appropriate treatment approach for patients and lead to better outcomes.

A Pilot Study of Dynamic Magnetic Resonance Dacryocystography Imaging to Assess Functional Epiphora.

OBJECTIVE: To evaluate dynamic magnetic resonance dacryocystography (MRDCG) in eyes with functional epiphora. METHODS: We included prospective eyes with epiphora if no alternative cause was found on clinical examination, were patent on syringing, had no obstruction or stenosis on DCG, and had an abnormal DSG. MRDCG was performed to qualitatively assess for block or patency and quantitatively measure tear transit time. We compared measurements to asymptomatic fellow eyes and to historical reference values from asymptomatic eyes. RESULTS: We included 26 symptomatic eyes of 19 patients (median age 63 years). There was a block on MRDCG in 18 (69%) eyes and patency in 8 (31%) eyes. The block occurred at the sac-nasolacrimal duct (NLD) junction in 9 (50%), proximal NLD in 5 (28%), mid-NLD in 1 (5.6%), and distal NLD in 1 (5.6%) eye(s). No contrast was observed in the lacrimal system in two eyes. For eyes patent on MRDCG, median times to the sac, NLD, inferior meatus, first 25%, and first 50% of the fundus-to-nose distance (FND) were 22, 54, 118, 34, and 84 s, respectively. Times to the sac, NLD, and to fill the first 25% and 50% of the FND were significantly longer than historical values from asymptomatic lacrimal systems (p = 0.017, 0.050, 0.035, 0.017, respectively). CONCLUSION: MRDCG shows a high rate of block in functional epiphora. However, DSG and MRDCG results may not always correlate. The improved temporal resolution of this emerging modality may be advantageous in the critical first 2 min of tear transit.

Evaluation of epiphora by topical contrast-enhanced CT and MR dacryocystography: which one to choose?

BACKGROUND: Our study aims to compare non-invasive imaging such as topical computed tomography dacryocystography (CTD) and topical magnetic resonance dacryocystography (MRD) in patients with epiphora. PURPOSE: To evaluate the practicability of topical contrast media during helical CTD and topical saline during MRD to reveal obstruction in the nasolacrimal drainage system (NLDS). MATERIAL AND METHODS: Twenty participants with nasolacrimal duct obstruction were observed for two years. Ten participants underwent CTD and the other 10 participants underwent MRD. Images were analyzed by two radiologists. Participants were also asked about the level of discomfort of the contrast material versus the saline solution. RESULTS: The NLDS was seen on both CTD and MRD. Very good agreement between the two observers (κ value > 0.81) was seen according to the κ statistics. CTD multiplanar and 3D images allowed for precise diagnosis of the point of obstruction whereas, the MRD did not require any contrast material and showed the point of obstruction. Saline was more comfortable for the patients than topical contrast (P < 0.05). CONCLUSION: Topical CTD and MRD are non-invasive techniques that can visualize the degree and level of obstruction in the NLDS than conventional invasive cannulation dacryocystography. CTD is useful in visualizing the point of obstruction and smaller drainage structures. However, it is a source of ionizing radiation to the lens. The benefit of MRD is that it requires no contrast or radiation; however, it is poor in depicting the bone anatomy and smaller drainage structures. Finally, saline was better tolerated by patients than topical contrast.

Soft stop on syringing and probing may have a high false-positive rate in diagnosing pre-sac obstruction.

PURPOSE: To determine the diagnostic value of 'soft stops' encountered during lacrimal syringing and probing. METHODS: Single-center retrospective review. Adult patients with epiphora attending a tertiary lacrimal clinic from May 2010 to April 2021 were reviewed. Cases with evidence of soft stop encountered during lacrimal syringing/probing were included, and patients with possible canaliculitis or a history of lacrimal surgery were excluded. Findings of syringing/probing consistent with pre-sac obstruction were correlated with dacryocystography (DCG) and surgical findings. RESULTS: 53 (10.2%) canalicular systems had soft stops on syringing/probing and were included in the analysis. The mean age of the patients was 63.8 ± 15.6 (range 28-87) years, and 27 (65.9%) were females. Intraoperative examination findings were available for 27 of 30 cases that underwent lacrimal surgery and DCG was available for 40 systems. Pre-sac obstruction found on syringing/probing was confirmed in 40% and 37% of cases on DCG and surgery, respectively. The correlation between syringing/probing and DCG was stronger for canalicular than for common canalicular location (p = 0.016). Canalicular stenosis on syringing/probing manifested as pre-sac abnormality on DCG in 5/7 (71.4%) compared to 0/6 common canalicular stenosis cases (p = 0.021). Based on the surgical findings, the false-positive rate of a soft stop on syringing/probing was highest for common canalicular 'stenosis' (100%) and lowest for canalicular 'block' (45.5%; p = 0.093). Findings of pre-sac obstructions on DCG were confirmed in 85.7% of the cases intraoperatively (p = 0.035 compared to syringing/probing alone). CONCLUSIONS: Soft stops on probing showed poor correlation with DCG and surgical findings, particularly in common canalicular location.

Non-contrast MR dacryocystography for the evaluation of epiphora and recurrent dacryocystitis: A preliminary study.

INTRODUCTION: Obstruction of the lacrimal drainage represents a common ophthalmologic issue. The blockage may interest any level of the lacrimal drainage pathway, and it is important to find the site of obstruction to plan the most appropriate treatment. In this study, findings from magnetic resonance (MR) dacryocystography were compared with findings from endoscopic and surgical procedures to evaluate the accuracy of MR dacryocystography in localizing the site of nasolacrimal duct obstruction. METHODS: We enrolled twenty-one patients with clinical suspicion of nasolacrimal duct obstruction who underwent dacryoendoscopy and surgery. MR dacryocystography was performed with a heavily T2-weighted fast spin echo sequence in the coronal planes. Before the MRI was performed, a sterile 0.9% NaCl solution was administered into both conjunctival sacs. For each examination, two independent readers (with 8 and 10 years of experience in head and neck imaging) evaluated both heavily 3D space T2-weighted and STIR sequences. RESULTS: Stenosis/obstruction of nasolacrimal duct or lacrimal sac was diagnosed in all 21 patients who underwent MRI dacryocystography. In particular, the site of the obstruction was classified as lacrimal sac in 12 (57%) patients, nasolacrimal duct in 6 (29%) patients, and canaliculi in 3 (14%) patients by both readers. By comparison with the evidence resulting from the endoscopy, there were differences between MRI dacryocystography and dacryoendoscopy in the evaluation of the obstruction's site in three patients, with an overall accuracy of 85.7%. CONCLUSION: MR dacryocystography allows a non-invasive evaluation of the lacrimal drainage pathway, valid for the planning of the most appropriate treatment.

Reference role of middle turbinate axilla in lacrimal sac localization assisted by computed tomographic dacryocystography-reference value of middle turbinate in locating lacrimal sac.

BACKGROUND: The middle turbinate axilla (MTA) has always been used as a stable anatomic landmark for endoscopic surgeons to locate the lacrimal sac on the lateral nasal wall. Yet, little is known about whether the lacrimal sac size will affect the positioning effect of MTA on lacrimal sac. The aim of this study was to investigate the regularity of lacrimal sac size and lacrimal sac localization through the reference position of the MTA on computed tomographic dacryocystography (CT-DCG) images. METHODS: A series of 192 endoscopic dacryocystorhinostomy (DCR) surgeries were performed. All the patients had been diagnosed as unilateral nasolacrimal duct obstruction and received CT-DCG examinations. According to the maximum transverse diameter of the lacrimal sac on CT-DCG, the patients were classified into three groups. Measurements were taken on CT-DCG parasagittal images. RESULTS: The average distance from the sac superior fundus (SSF) to the MTA was 7.52 mm ± 3.23 mm, and it increased with the increase of the maximum transverse diameter of the sac among groups (p < 0.01). The average distance from the common canaliculus (CC) to the MTA was 3.95 mm ± 2.49 mm. No significant difference was observed among the groups (p = 0.11). The average distance from the CC to the SSF was 3.41 mm ± 1.31 mm, and it increased with the increase of the sac transverse diameter among groups (p < 0.01). CONCLUSIONS: The lacrimal sac can be accurately located on the lateral nasal wall by the reference position of the MTA on CT-DCG images. The distance of the SSF to the MTA and the SSF to the CC is related to the lacrimal sac size. The relative position of the CC to the MTA is relatively stable on CT-DCG images, which make it possible to locate the lacrimal sac of different sizes and the corresponding nasal mucosa incision design in endoscopic DCR.

Anatomy of the nasolacrimal duct in Persian cats determined by computed tomographic dacryocystography.

OBJECTIVE: This study sought to describe the anatomical characteristics of the nasolacrimal duct of Persian cats as observed by computed tomographic dacryocystography. ANIMAL STUDIED: Ten cats weighing 3-6 kg (three live cats and seven cadaveric specimens). PROCEDURES: The animals were submitted to bilateral computed tomographic dacryocystography, totaling 20 nasolacrimal ducts. Dorsal, sagittal, and transverse planes were studied. Two additional skulls were also dissected following latex injection into the nasolacrimal duct. The length and width of the nasolacrimal duct and lacrimal canaliculi, and the distance between the nasolacrimal duct and the root of the upper canine tooth at the point of closest proximity were measured. RESULTS: The nasolacrimal duct followed a convoluted course, particularly in the middle and rostral portions. Duct stenosis (width reduction equal to or >75%) and dilations (width increase equal to or >50%) were also detected, particularly in the rostral portion. Nasolacrimal duct length and width ranged from 1.3 to 1.5 cm and 1.5 to 2.3 mm, respectively. Mean lacrimal canaliculus length and width corresponded to 3.1 mm and 0.4 mm, respectively. Mean distance from the nasolacrimal duct to the canine tooth was 2.4 mm. The root of this tooth interfered with the course of the nasolacrimal duct. CONCLUSION: This study provided anatomical information for clinical assessment of the nasolacrimal drainage system in Persian cats.

Degree of agreement between dacryoscintigraphy and dacryocystography examinations results in primary acquired nasolacrimal duct obstruction.

BACKGROUND: This diagnostic study aimed to assess degree of agreement between dacryoscintigraphy and dacryocystography as supporting examinations in patients with primary acquired nasolacrimal duct obstruction (PANDO). Patients with PANDO who complained of epiphora and visited our outpatient clinic were subsequently sent for dacryoscintigraphy and dacryocystography examinations. Side effects and convenience of both examinations were assessed by observation and questionnaire. MATERIAL AND METHODS: Through irrigation and probing, there were 47 out of 62 eyes were found with PANDO. As much as 87.1% subjects were female, with mostly (74.2%) aged > 40 years old. With dacryoscintigraphy, time needed to reach sac was 0 minutes, 5 minutes (duct), and 12.5 minutes (nasal cavity). RESULTS: Degree of agreement between both examinations was 83.8% to determine obstruction and 70.9% to locate obstruction. There were 22 subjects complained about pain in dacryocystography examination while none with dacryoscintigraphy (p < 0.005). Sixteen subjects feel dacryoscintigraphy examination was more convenient, eleven subjects feel dacryocystohraphy was more convenient, while 4 subjects feel the two examinations were similar. CONCLUSIONS: Even though dacryocystography examination was considered more painful than dacryoscintigraphy, both examinations had high convenience level for patients. Dacryoscintigraphy and dacryocystography also had a good agreement in detecting and locating obstruction in PANDO.

Possibility of Pseudo-Obstruction in Lacrimal Canalicular Obstruction Diagnosed with Dacryocystography.

INTRODUCTION: Endoscopic dacryocystorhinostomy (DCR) is the treatment of choice for patients with lacrimal drainage system obstruction. Dacryocystography (DCG) is one of the most common preoperative studies and considered as a useful test demonstrating the anatomy of lacrimal drainage systems. OBJECTIVE: This study was designed to evaluate the diagnostic efficacy of DCG for canalicular obstruction and to compare surgical outcomes between true-obstruction versus pseudo-obstruction diagnosed with DCG. METHODS: A retrospective study was performed on 45 consecutive patients with lacrimal canalicular obstruction who had underwent endoscopic DCR with silicone tube insertion from January 2009 to December 2014 at a single tertiary hospital. A review of medical records included demographic data, preoperative symptoms and signs, results of intraoperative canalicular probing, and surgical outcomes including the postoperative symptom improvement and endoscopic finding. RESULTS: Of 45 patients, 34 patients (75.6%) had true-canalicular obstructions and 11 patients (24.4%) had pseudo-canalicular obstructions. The success rate of endoscopic DCR was 50% (17 of 34) in cases with true-canalicular obstruction while 90.9% (10 of 11) in pseudo-canalicular obstruction (p value <0.05). No intraoperative or postoperative complications including sinusitis or synechia were found. CONCLUSIONS: About a quarter of lacrimal canalicular obstruction cases diagnosed with DCG seem to be pseudo-obstruction. The success rate of endoscopic DCR in pseudo-canalicular obstruction is similar to that of saccal and nasolacrimal ductal obstruction.

Obstrução da via lacrimal após radioiodoterapia: relato de caso e conduta / Lacrimal duct obstruction after radioiodine therapy: case report and treatment

Iodoterapia representa a terapia com iodo radioativo. A radiação beta emitida pelo iodo radioativo são partículas que irão se armazenar no tecido da tireóide destruindo as células cancerígenas que ainda restaram após a cirurgia (tireoidectomia). É importante enfatizar este possível efeito deletério da terapêutica, a qual afeta a mucosa da via lacrimal, sendo o resultado do processo de inflamação e cicatrização vascular, produzindo transtornos hipovasculares, hipocelulares e hipóxicos.

Iodotherapy represents the radioactive iodine therapy. The beta radiation emitted by radioactive iodine are particles that will be stored in the thyroid tissue destroying cancer cells that were left after surgery (thyroidectomy). It is important to emphasize a possible deleterious effect of therapy which affects the mucosa of the lacrimal system which results in a process of vascular inflammation and scarring producing disorders hypovascular, hypocellular and hypoxic.