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Abstract Background Radioactive iodine 131 (I-131) is used in the treatment of differentiated thyroid cancer after thyroidectomy; however, its accumulation in non-thyroidal regions may give false positive results on iodine whole body scan (WBS). Only a few cases of radioiodine uptake in the orbital region in patients with thyroid cancer have been reported, which could be due to metastasis or false positive causes resulting from contamination or inflammatory etiology. Case presentation We describe a case of 49-year-old male with history of papillary thyroid carcinoma. The follow-up I-131 whole body scan showed a focus of increased radiotracer uptake in the region of left orbit. Correlative single photon emission computed tomography (SPECT-CT) showed that uptake was due to stenosis of the left nasolacrimal duct causing obstructive symptoms on left side. Dacryoscintigraphy also demonstrated significant obstruction of left nasolacrimal system. Conclusions The nasolacrimal duct obstruction is a rare adverse event after I-131 therapy that can result in an accumulation of radioiodine on whole body scan, mimicking metastasis. The use of additional spot views and SPECT-CT images along with thyroglobulin levels can help physicians in clarifying the situation in these uncertain cases.

Purpose: To determine the etiology of epiphora in a tertiary Australian lacrimal clinic and highlight the high proportion of 'functional' cases. Methods: Single-center retrospective review: Records of adult patients presenting to a tertiary lacrimal clinic from January 2011 to February 2021 with epiphora were reviewed. Patients underwent testing with syringing/probing and lacrimal imaging to reach a diagnosis of functional epiphora. Functional epiphora was diagnosed based on the exclusion of alternate causes of epiphora on clinical examination, patent lacrimal syringing, normal dacryocystography, and delay on dacryoscintigraphy. Results: Five hundred and seventy-six symptomatic eyes of 372 adult patients (mean 66.2 ± 15.5 years, 63.4% females) with epiphora were evaluated for causes. Post-sac obstruction (stenosis/complete obstruction) and functional epiphora (non-anatomical delay) were the most common causes of presentations to the lacrimal clinic (26% each). Functional epiphora with post-sac delay was substantially more common than functional epiphora with pre-sac delay (89% vs. 11% of functional epiphora cases). In 16% of the cases, no cause for the epiphora was found while more than one cause (multifactorial) was present 11% of the time. Conclusion: Functional epiphora was found to be as common as a nasolacrimal anatomical obstruction when lacrimal imaging is utilized. [ABSTRACT FROM AUTHOR]

Background: Radioactive iodine 131 (I-131) is used in the treatment of differentiated thyroid cancer after thyroidectomy; however, its accumulation in non-thyroidal regions may give false positive results on iodine whole body scan (WBS). Only a few cases of radioiodine uptake in the orbital region in patients with thyroid cancer have been reported, which could be due to metastasis or false positive causes resulting from contamination or inflammatory etiology. Case presentation: We describe a case of 49-year-old male with history of papillary thyroid carcinoma. The follow-up I-131 whole body scan showed a focus of increased radiotracer uptake in the region of left orbit. Correlative single photon emission computed tomography (SPECT-CT) showed that uptake was due to stenosis of the left nasolacrimal duct causing obstructive symptoms on left side. Dacryoscintigraphy also demonstrated significant obstruction of left nasolacrimal system. Conclusions: The nasolacrimal duct obstruction is a rare adverse event after I-131 therapy that can result in an accumulation of radioiodine on whole body scan, mimicking metastasis. The use of additional spot views and SPECT-CT images along with thyroglobulin levels can help physicians in clarifying the situation in these uncertain cases. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate nasolacrimal drainage and accompanying additional occlusions after topical steroid treatment in punctal stenosis patients with recurrent epiphora. We evaluated the change in nasolacrimal drainage and the effect of the presence of additional pathology on the response to noninvasive medical treatment in the 6-month follow-up after treatment. Materials and Methods: Fifty-two patients with unilateral punctal stenosis and ipsilateral epiphora were included in our study. The mean age of the patients was 68.23±9.67. All patients received topical steroids for punctal stenosis. Dacryoscintigraphy was performed on all patients to evaluate additional pathologies before treatment. In the pre-treatment dacryoscintigraphy, there was obstruction at the lacrimal sac entrance in 7 (13%) patients, at the sac outlet in 24 patients (46%), and in the nasolacrimal duct in 21 patients (40%). Dacryoscintigraphy was repeated 6 months after treatment to evaluate the response to treatment. None of the patients had a history of surgery for the punctum or nasolacrimal system. Ophthalmological examination findings were normal on the non-complaining side. Dacryoscintigraphy on both sides was performed. Scintigraphic images were evaluated both quantitatively and qualitatively. Regions of interest were plotted on specific areas for quantitative evaluation. Results: Thirty-four (81%) patients were female. The punctal region had an edematous appearance in patients with punctal stenosis. Dacryoscintigraphy was repeated 6 months after the treatment to evaluate the response to the treatment. Nasolacrimal drainage was normal in 71% of patients who had stenosis at the entrance and exit of the sac as a result of punctal stenosis treatment. Epiphora and stenosis at the same level persisted in all 21 patients with nasolacrimal duct stenosis. Conclusion: Punctal stenosis is a common condition, especially in elderly patients. Methods with excellent patient compliance in diagnosis and treatment should be preferred first. Dacryoscintigraphy is a convenient method to identify patients for whom aggressive methods are required. [ABSTRACT FROM AUTHOR]

Purpose: To assess the anatomical and functional outcomes in patients who underwent surgery for canalicular laceration and did not experience significant epiphora, and to compare these outcomes with contralateral uninjured eye., Method: Dacryoscintigraphy, anterior segment optical coherence tomography (OCT), MUNK scores, and a satisfaction questionnaire were administered to 24 patients who had canalicular laceration repair without significant epiphora and had a minimum of 6 months of follow-up. Tear meniscus height (TMH), depth (TMD), and area (TMA) were measured using anterior segment OCT and compared with the values in the uninjured eye., Results: Sixteen patients (67 %) had lower, 7 (29 %) had upper canaliculus, and one (4 %) had lacerations in both canaliculi. Five patients (20.83 %) had concomitant orbital fractures, and three patients (12.5 %) underwent additional repair for corneoscleral laceration. Bicanalicular silicone tube intubation was performed in one patient, while Mini-Monoka stent intubation was used for all other patients. The mean follow-up period was 41 ± 22.3 months, and the mean interval between trauma and surgery was 30.2 ± 29 h. The mean duration until tube removal was 3 ± 2.54 months. The MUNK score was 1 in eight patients (33 %) and 0 in sixteen patients (67 %). Canalicular lacerations occurred due to home accidents in 8 patients, work accidents in 4, assaults in 5, and traffic accidents in 7. Dacryoscintigraphy showed drainage of tracer into the nasal cavity in dynamic imaging for 12 patients. Five patients had retention in the sac, four had prolonged and reduced drainage, one had reduced drainage, and two showed no drainage in the first and second hour images. In the operated eye, the mean tear meniscus height (TMH) was 279.6 µm, depth (TMD) was 215 µm, and area (TMA) was 28.9 µm². In the healthy eye, the mean TMH was 221.5 µm, TMD was 152.5 µm, and TMA was 15.3 µm². The anterior segment OCT values for the affected eye were statistically significantly higher than those for the healthy eye (p = 0.044 for TMH, p = 0.003 for TMD, p = 0.006 for TMA). TMD and TMA were statistically significantly higher in patients with a MUNK score of 1 (p = 0.019 for TMD, p = 0.05 for TMA). Abnormal dacryoscintigraphy results were more common in patients with globe injuries requiring additional surgery., Conclusion: Although patients did not report epiphora after canalicular laceration repair, our observations indicated potential functional and anatomical differences in dacryoscintigraphy and anterior segment OCT compared to their healthy eyes. We believe that close follow-up is crucial to identify and address any issues that may arise in the future following surgery., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024. Published by Elsevier B.V.)

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]

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. [ABSTRACT FROM AUTHOR]

Aims: To investigate the prevalence of subclinical anatomical and functional abnormalities of lacrimal drainage in fellow asymptomatic eyes of unilateral epiphora using dacryocystography and dacryoscintigraphy., Methods: Retrospective case note review of lacrimal imaging of adult patients presenting to a hospital Oculoplastic clinic with unilateral epiphora over 10 years., Results: A total of 172 patients with unilateral epiphora were included. The median age was 67 (range 18-96 years). A dacryoscintigraphy (DSG) abnormality was present in 54 (42%) asymptomatic eyes, and dacryocystography (DCG) abnormality in 10 (10%). The most common finding on DSG was no delay in 76 eyes (58%), and most common DSG abnormality was post sac delay in 51 (39%) eyes. The most common finding on DCG was no obstruction in 88 (90%) eyes, and the most common DCG abnormality was post sac stenosis (7.1%). Of the 92 asymptomatic eyes with both DCG and DSG, 53 (57%) showed neither an obstruction on DCG or delay on DSG, and 28 (30%) showed a post sac delay on DSG and no abnormality on DCG., Conclusion: Greater than a third of asymptomatic eyes displayed post sac delay on DSG, frequently without accompanying anatomical obstruction on DCG. Subclinical DSG delay in asymptomatic eyes may represent physiological variation in tear transit time, subclinical lacrimal drainage dysfunction or anatomical stenosis undetected by DCG. Furthermore, the DSG results of fellow asymptomatic eyes in unilateral epiphora may not represent a normal standard that can be utilised for comparison. Further investigation with dacroyendoscopy, the use of control eyes, and long term follow up is required.