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Purpose: To elucidate the role of syringing in assessing nasolacrimal duct (NLD) stenosis and non-anatomical functional NLD delay. Methods: Consecutive adult patients with epiphora attending a tertiary lacrimal clinic from June 2011 to March 2021 were reviewed. Cases with evidence of canalicular stenosis or other identifiable causes of epiphora were excluded. Following syringing, patients were investigated with dacryocystography (DCG) and dacryoscintigraphy (DSG). The sensitivity and specificity of syringing were evaluated using the combined findings on DCG and DSG. Results: A total of 289 symptomatic lacrimal systems (197 patients; mean age 65.5 ± 14.9 years, 66% females) were included. More than one-third of cases with both normal DCG and DSG were noted to have some degree of reflux on syringing (specificity = 65.1%, 95% CI 50.2–77.6%). The sensitivities were considerably low for NLD stenosis (i.e., stenosis on DCG and delay on DSG) and for functional NLD delay (i.e., normal DCG and delay on DSG), of which 43.7% (95% CI 32.2–55.9%) and 54.3% (95% CI 45.7–62.7%) had full patency on syringing, respectively (p = 0.17). Conclusions: Full patency on syringing was unreliable for ruling out NLD stenosis and functional delay. Furthermore, a positive syringing may be associated with functional NLD delay and cannot reliably differentiate it from stenosis. [ABSTRACT FROM AUTHOR]

Assessment of lacrimal resistance in patients with patent lacrimal systems is important in determining whether dacryocystorhinostomy (DCR) surgery is appropriate. Current techniques, including lacrimal syringing and dacryoscintigraphy (DSG), can be unreliable. We compare the results of a manometric tear duct test (mTDT) irrigation technique with DSG in these patients. All symptomatic patients in a specialist lacrimal clinic had full work-up apart from syringing. Lacrimal resistance was assessed using mTDT which applies a fixed head of fluid pressure via a cannula sealed to punctum. Conventional syringing was also performed in cases with abnormal mTDT. Symptomatic patients with delayed tear clearance, no external cause for watering and patent lacrimal systems had DSG. MTDT and DSG results were compared, including in asymptomatic fellow eyes. 105 tear ducts were examined, 85 symptomatic. Symptomatic eyes had a significantly higher mean mTDT resistance (p =.0003) and more had abnormal mTDT (52%) compared to asymptomatic eyes (10%). Although mean tear duct resistance was higher in those with nasolacrimal duct stenosis (NLDS) than freely patent (FP) on syringing (8.5 vs 10.8 dpm), this was not significant (p =.6). High proportions of both FP and NLDS groups had no flow at all on mTDT (60% and 53%, respectively). DSG showed no significant difference in the symptomatic versus asymptomatic eyes (p =.36), nor between those with a normal or abnormal mTDT (p =.25), nor between FP and NLDS groups (p =.25). In contrast to DSG, the mTDT provides valuable, objective information on lacrimal resistance that can guide a decision to DCR surgery. [ABSTRACT FROM AUTHOR]

Purpose: To measure tear clearance values in patients with meibomian gland dysfunction (MGD) with a dynamic nuclear medicine method, namely, dacryoscintigraphy (DSCI).Methods: Twenty-four MGD patients and 24 healthy volunteers were examined. During DSCI one drop of a solution with 100 MBq/mL99mTc sodium pertechnetate was instilled with a micropipette into the lacrimal lake of both eyes. Measurements were performed according to a dynamic data acquisition protocol, which resulted in summed DSCI images. Data were also evaluated separately in special regions of interest (ROI), and consecutive time activity curves were created. Tear clearance (T½) values were calculated based on the activity curves. In addition, tear osmolarity measurements, tear breakup time (tBUT), and Schirmer I (STI) tests were performed prior to DSCI examination.Results: The T½ values were 29.91 ± 11.61 min in MGD patients and 6.26 ± 1.5 min in healthy controls. Tear osmolarity parameters were 308 ± 9.41 mOsm/L and 288.9 ± 6.4 mOsm/L, tBUT values were 5.54 ± 2.73 s and 11.4 ± 2.7 s, while the STI test values were 6.17 ± 2.78 mm and 13.58 ± 3.8 mm, respectively. The differences were significant (p < 0.01) in all cases.Conclusions: Although the MGD patients' lacrimal drainage systems were patent their tear clearance values were significantly higher than those of healthy volunteers, which may be caused by decreased drainage of tears from the eyes towards the nasal cavity. The understanding of new features regarding the altered physico-chemical characteristics of MGD tears has been augmented by the results of this study. [ABSTRACT FROM AUTHOR]

Importance: This study assesses the interobserver agreement on dacryocystography (DCG) and dacryoscintigraphy (DSG) findings. Background: There are no standard grading criteria to guide the interpretation of conventional DCG and DSG findings and therefore there may be a degree of subjectivity. This study evaluates the level of interobserver agreement in the interpretation of DCG and DSG findings. Design A retrospective observational study at the Royal Adelaide Hospital. Participants: A total of 165 patients who presented with epiphora with 276 DCGs and 290 DSGs performed were included in this study. Methods: DCG and DSG images were obtained, anonymized, randomized and interpreted by three independent oculoplastic surgeons. Standard grading criteria were set for both DCG and DSG images. Data from all observers were analysed for interobserver agreement using Kappa (κ) statistics, generated using a variation of Cohen's kappa for multiple observers. Main Outcome Measures: Level of interobserver agreement (κ values) in the grading of DCG and DSG findings. Results: There was an overall moderate interobserver agreement for DCG findings (κ = 0.55), with the highest agreement on interpreting canalicular obstruction (κ = 0.80), followed by proximal nasolacrimal duct obstruction (κ = 0.67) and normal patency (κ = 0.63). There was an overall fair interobserver agreement for DSG findings (κ = 0.36), with the best being moderate agreement (κ = 0.42‐0.50) for interpreting pre‐sac delay and post‐sac proximal delay. Conclusions and Relevance: DCG offers good reliability in interpreting patent and obstructed systems. On the other hand, DSG has poor agreement and highlights some of the limitations in the ability to guide epiphora management. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to evaluate the functional success rates using dacryoscintigraphy (DSG) after transcanalicular diode laser dacryocystorhinostomy (TDL-DCR).Methods: In this retrospective study, we investigated the records of 56 patients who underwent TDL-DCR for unilateral primary acquired nasolacrimal duct obstruction and anatomic patency was achieved. The lacrimal drainage systems of the other eyes of the patients were normal and were selected as control group. The functional success was evaluated with tear transit time (TT) on DSG and epiphora complaints' score (ECS) at postoperative 6 months.Results: Twenty-two (39%) of the patients were male and 34 (61%) were female, with a mean age of 46.6 (21-64). The dacryoscintigraphic findings of the operated and healthy eyes showed that there was statistically insignificant prolongation in the tear TT at the operated side at postoperative 6th month (P > 0.05). The mean ECS of operated eyes was 0.89. Functional success was achieved in 43 (76.8%) patients when the ECS of 0 and 1 was accepted as successful. A statistically significant delay in drainage was observed in DSG in all of the cases with epiphora score of 2 and 3 (P < 0.05). The tear TT was prolonged with the age increase (P < 0.05), but there was no significant difference concerning the gender.Conclusion: DSG is an effective tool to evaluate the functional success of TDL-DCR. [ABSTRACT FROM AUTHOR]

Dacryoscintigraphy is a noninvasive, simple, easy to perform imaging modality used in the evaluation of epiphora. However, it is an infrequently done study in nuclear medicine departments. A standardized protocol and a systematic interpretation of the scans help in answering the queries of the clinicians in cases of epiphora. We have attempted to build a pictorial essay of the various findings detected on dacryoscintigraphy. [ABSTRACT FROM AUTHOR]

Introduction: This study was done to determine the site of obstruction in lacrimal drainage system in Asian patients suffering from epiphora and to determine the transit time taken for the tracer material to reach the lacrimal sac and the nasal cavity. Methods: Dacryoscintigraphy was performed using radionuclide technetium-99m pertechnetate (99mTc) in 34 patients suffering from unilateral or bilateral epiphora and in 3 cases of post-operative dacryocystorhinostomy. The site of obstruction was noted during the dynamic scintigraphy procedure. The time taken for the tracer material to reach the lacrimal sac in all the eyes and the nasal cavity in the eyes with patency of nasolacrimal duct was determined. Results: Complete obstruction of nasolacrimal duct (NLD) was noted in all 22 unilateral cases. However, in 4 of the contralateral asymptomatic eyes in these patients complete obstruction of NLD was detected. Out of 12 bilateral cases, complete obstruction of NLD was noted in both eyes in 4 cases, and in one eye only in 8 cases. There was partial obstruction of NLD in the other eye in these 8 patients. The mean transit time taken for the tracer material to reach the lacrimal sac was 8 seconds (range 5 - 14 seconds) and to the nasal cavity was 6 minutes 20 seconds (range 2 minutes 16 seconds - 12 minutes). Conclusion: This non-invasive procedure helps in the diagnosis of partial obstruction of NLD which can be missed by syringing procedure. The time taken for the tears to drain into the nasal cavity can also be measured in eyes with patent nasolacrimal duct by this procedure. [ABSTRACT FROM AUTHOR]

Epiphora is a common problem seen by the ophthalmologist. There are numerous etiologies of a watering eye, and the underlying diagnosis is not always clear. A variety of in-office examination techniques and procedures exist to aid with diagnosis and determination of appropriate therapy, but sometimes the diagnosis remains elusive, or an instituted therapy fails. Lacrimal imaging, particularly in these cases, can be helpful in assessing the function and anatomy of the lacrimal drainage system. This review serves to examine the literature of the last 10 years concerning imaging of the lacrimal drainage system. [ABSTRACT FROM AUTHOR]

Lacrimal scintigraphy (LS) or dacryoscintigraphy can demonstrate abnormalities in 80%-95% of patients with symptoms of epiphora and a patent lacrimal system on syringing and up to 40% asymptomatic individuals. Precise localization of the site of delay may not always be possible due to lack of anatomic detail on LS. LS is considered useful in patients with epiphora with delayed tear clearance and patency to syringing and suspected to have either nasolacrimal duct (NLD) stenosis or lacrimal pump failure. It remains unclear, however, as to whether LS can reliably distinguish between the two. The literature reports considerable variation in the technique, normative data, analysis, and interpretation of LS. Qualitative or visual analysis is simpler to perform and to our knowledge used more frequently in comparison to quantitative analysis. There is little extra information to be gained from LS in cases with complete NLD obstruction or severe NLD stenosis on syringing. [ABSTRACT FROM AUTHOR]

Background: Dacryoscintigraphy is a noninvasive method frequently used for assessment of the lacrimal drainage system. Sometimes conflicting results with patients' complaints are obtained, which have no clear explanation. In our hypothesis, follow-up of patients evaluated with dacryoscintigraphy could be helpful in determining possible explanations for these conflicting results. Method: Thirty-eight consecutive patients (76 eyes) who had not previously undergone dacryocystorhinostomy or probing were entered in the study. Following instillation of 4 MBq 99mTc-pertechnetate, a routine procedure of dacryoscintigraphy was performed. After a mean follow-up time of 1.2 ± 0.3 years (range 0.9-1.6 years), all patients were reassessed clinically. Results: Using initial patients' symptoms as the gold standard, the sensitivity, specificity, NPV, and PPV of dacryoscintigraphy were calculated to be 82.1%, 75%, 60%, and 90.1%, respectively. The kappa value as a measure of agreement was 0.52. Considering the follow-up study as the gold standard, the sensitivity, specificity, NPV, and PPV were calculated as follows, respectively: 96.3%, 90.4%, 96.3%, and 90.4%. The kappa value was 0.86. There were three initially symptom-free eyes with obstructive pattern on the scans, which developed epiphora on the follow-up. In fact, these eyes were initially classified as false positive, but follow-up assessment showed that they were true-positive scans in a subclinical state. Conclusion: Despite certain drawbacks inherent to the technique, dacryoscintigraphy provides valuable independent information and allows more accurate management decisions. In some patients, data obtained from lacrimal scintigraphy could be predictive, and it makes possible determination of subclinical nasolacrimal duct obstructions. [ABSTRACT FROM AUTHOR]

AimTo measure the degree of physiological patency of the tear drainage system using dacryoscintigraphy before and after external dacryocystorhinostomy (EDCR) in relation to patient complaints.MethodsProspective evaluation of 29 eyes of 24 patients with primary acquired nasolacrimal duct obstruction (PANDO) who underwent EDCR. The epiphora complaints were measured subjectively. Dacryoscintigraphy was performed in all eyes preoperatively, and was repeated 6 months after DCR together with the complaints score. For evaluation of dacryoscintigraphy, we determined T1 (percentage of administered dose still present after 1 min) and linear clearance rate (LCR), defined as: 100%(T1−T15)/T1) from the tracer disappearance curve. Dacryoscintigraphy findings were compared with the results of 20 eyes of normal volunteers without any symptoms. Scintigraphic findings were compared before and after the operation, with the change in patient complaints score as well as with normal values.ResultsSignificant improvement occurred after the operation in the complaints score, T1 and LCR. However, despite absence of complaints (score=0) postoperative scintigraphic values were still abnormal as compared to normal individuals.ConclusionDespite almost complete remission of epiphora complaints, DCR does not result in normalization of the tear drainage system.Eye (2008) 22, 414–419; doi:10.1038/sj.eye.6702656; published online 24 November 2006 [ABSTRACT FROM AUTHOR]

Background: At the present time, only visual analysis is implemented on dacryoscintigraphic images and quantitative assessments are not routinely obtained. The authors have designed a novel, simple, quantitative method for the diagnosis of sac and post-sac obstructions based on the dacryoscintigraphic images. Method: Fifty-nine patients with severe unilateral epiphora were included and the contralateral asymptomatic eyes were used as controls. After ocular instillation of 0.1 cc isotonic saline containing 4 MBq 99mTcO4, dynamic images were obtained for 20 minutes. Visual interpretation was done by two blinded specialists in nuclear medicine. A Time-Activity Curve (TAC) was generated for each eye and its pattern was divided to plateau type, shallow-down sloping and deep-down sloping. The excretion ratio (expressed as the percentage of drained activity) in the 2nd, 3rd, 5th, 7th, 10th, 15th and 20th minute of the study was calculated based on the following formula: (the total count in the region of interest (ROI) in the 1st minute - the total ROI count in the 2nd, 3rd, 5th, 7th, 10th, 15th or 20th minute/the total ROI count in the 1st minute) × 100. The results of the quantitative analysis were compared with the clinical symptoms, visual analysis and TAC pattern. Results: At the optimal cut-off points for the 2nd, 3rd, 5th and 7th minute, the sensitivity of the prediction of obstruction was 76%, 72%, 71% and 69%, respectively. The correlation between visual interpretation and the TAC pattern was statistically significant. Conclusion: The quantitative evaluation of dacryoscintigraphic images would contribute greatly to achieving an easier and more objective interpretation of the scintigraphic results and also provides a reliable tool for inter-individual comparison and the follow-up of patients. As it is the first time that this innovative method has been examined clinically, it will be necessary to investigate its clinical utility in a larger series of patients. [ABSTRACT FROM AUTHOR]

Radionuclide dacryocystography (RNDCG) is a safe, physiologic method of evaluating lacrimal drainage. The technique is performed by placing a radioactive ``tear'' in the eye(s) and following the passage of radioactivity through the lacrimal drainage apparatus with a scintillation (gamma) camera. RNDCG is indicated in any patient with tearing who has a lacrimal drainage system which is open to irrigation. It is also useful in children, when clinical signs are equivocal. Interpretation is made by comparing a patient's scan to ``normal'' scans, or in unilateral cases, by comparing the symptomatic side to the asymptomatic side. Many causes of functional or partial lacrimal drainage obstruction can be detected and differentiated from various tear hypersecretion abnormalities. RNDCG also has many research applications. [ABSTRACT FROM AUTHOR]

We report a 37-year-old patient with the history of bilateral epiphora, who was referred to our department for dacryoscintigraphy imaging. The patient had bilateral obstruction of the lacrimal apparatus at the sac-duct level on the scintigraphy images. Delayed imaging showed Tc-99m pertechnetate uptake in the thyroid due to systemic absorption of the tracer from the conjunctiva. We recommend using tracers with large particle size and lower possibility of mucosal absorption for dacryoscintigraphy in order to decrease unnecessary thyroid radiation. [ABSTRACT FROM AUTHOR]