Comparison of dacryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction

Abstract

Aim-It appears from the literature that no standardised examination exists for patients with functional nasolacrimal duct obstruction. The role of dacryocystography and lacrimal scintigraphy was compared in the diagnosis and management of these patients. Method-Patients who were clinically diagnosed as having unilateral or bilateral functional nasolacrimal duct obstruction were prospectively entered into the study and data collected over 12 months in Moorfields Eye Hospital and Whipps Cross Hospital, London. All cases had, on separate occasions, a standardised dacryocystogram with delayed erect films and a lacrimal drainage scintigram. Results-45 lacrimal systems of 32 patients (mean age 62 years; 59% male) fulfilled the inclusion criteria. Abnormalities were detected with dacryocystography in 93% of systems and with lacrimal drainage scintigraphy in 95% of systems. Based on the results of previous quantitative studies, the positive scintigrams were subdivided into those demonstrating prelacrimal sac delay (13%), delay at the lacrimal sac/duct junction (35%), or delay within the duct (47%). Combining the two imaging techniques increased the sensitivity to 98%. Conclusions-Both investigations are very sensitive at detecting abnormalities in patients with a clinical diagnosis of functional nasolacrimal duct obstruction. Lacrimal drainage scintigraphy is a slightly more sensitive test, but missed an abnormality detected by dacryocystography in two (4%) systems. A combination of the two techniques gives the highest sensitivity with maximum anatomical and physiological information but, in clinical practice, it is reasonable to perform a dacryocystogram initially and proceed to scintigraphy only if contrast radiography is normal. (Br J Ophthalmol 1999;83:1032-1035

The role of “after washing imaging” in evaluation of tear drainage system by dacryoscintigraphy

“…The sensitivities of lacrimal scintigraphy for detecting obstruction in the symptomatic patients were reported 81.6% by Jabbour et al, 77% by Rose et al and 95% by Wearne et al The sensitivity of 96.3% and specificity of 90.4% were reported by Fard-Esfahani et al [14][15][16][17]. Our study showed high sensitivity (96.3%) and specificity (75.5%) as shown by previous studies mentioned above especially having the "after wash" studies.…”

Avaliação da epífora de cães usando dacriocistografia e tomografia computadorizada

“…O exame radiográfico contrastado realizado prestou-se como método de reconhecimento da anatomia e da localização das estruturas do sistema de drenagem lacrimal dos cães, proporcionando, também, a verificação da patência dessas estruturas, conforme também relatado por vários autores na Medicina e na Veterinária, como Caye et al (1986), Slatter (1990a), Habin (1993), Barnett et al (1995), Takano & Mendonça Júnior (1996), Carneiro Filho (1997, Pereira et al (1997), Shankar et al (1999), Stades et al (1999), Wearne et al (1999), Grahn (2002), Gelatt (2003, Winston & Prasse (2003), Kleiner et al (2004), Nykamp et al (2004) e Silva (2004), que apontam a dacriocistografia como importante exame auxiliar. No presente trabalho, foi possível avaliar anatomicamente o sistema lacrimonasal também pela dacriocistografia por tomografia computadorizada contrastada, o que auxiliou na avaliação do sistema lacrimonasal em pacientes com alterações nas vias lacrimais concordando com os autores Costa et al (1997) que afirmaram que a semiologia da via lacrimal excretora envolve dados da anamnese, avaliação anatômica e funcional.…”

Specific features of endoscopic dacryocystorhinostomy – case report

“…The CT-or MRI-DCG can determine if an anatomic obstruction exists within the outflow system, where the obstruction occurs, and gives excellent anatomic details, being of great help . On the other hand, the DSG performed with technetium-99m pertechnetate or technetium-99m-labeled sulfur colloid has a low resolution and lack of anatomical details 8,9 . In our cases, we used the Jones test, probing and irrigation associated with a cranio-facial CT or MRI scan.…”