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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]

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: 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.

Purpose: Epiphora is commonly caused by a relative or complete occlusion in the lacrimal drainage system (LDS), principally a nasolacrimal duct obstruction (NLDO). Dacryoscintigraphy (DSG), an extensively assessed imaging technique in diagnosing its abnormalities, can provide only planar images, according to which it needs to be improved. Our aim was to evaluate clinical utility of simultaneous DSG and single-photon emission computed tomography/computed tomography (SPECT/CT) combined with computed tomographic dacryocystography (CT-DCG) in the evaluation of LDS.Methods: Dynamic imaging with DSG was performed, and tracer radioactivity was detected by a gamma camera. Successively, SPECT/CT images of the involved region were gained, followed by CT-DCG, during which a contrast medium was syringed into the affected LDS, and finally contrast CT scans were obtained again from the same region.Results: Fifty-seven patients, mean age 54.25 (± 18.26) years all with unilateral NLDO and 32 control subjects, all with patent LDS, mean age 49.88 (± 18.61) years were evaluated in the study. Delayed outflow of tearing eyes was exposed to DSG compared to the fellow and control eyes. The highest value for sensitivity was observed for SPECT/CT, followed by CT-DCG and DSG techniques, while combining DSG with SPECT/CT, DSG with CT-DCG, and SPECT/CT with CT-DCG, the sensitivity increased to 96.49%, 92.98%, and 94.73%, respectively.Conclusions: Although DSG is a sensitive nuclear medicine method, it only provides useful clinical data when simultaneously supplemented with SPECT/CT and CT-DCG trials as they jointly can offer valuable information about the localization of an abnormality and verify stenosis or obstruction. [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]

Introduction: Epiphora in the presence of patent lacrimal system (functional epiphora) has remained one of the complex lacrimal problems. There is a lack of consensus regarding its diagnostic criteria and management options. Areas covered: The authors have extensively reviewed articles published on functional epiphora in terms of epidemiology, pathogenesis, clinical presentations, diagnostic modalities, treatment outcomes, and limitations. Expert opinion: Patients with functional epiphora have similar frequency and severity of epiphora as in primary acquired nasolacrimal duct obstruction with lesser incidence among children. Dacryoscintigraphy or dacryocystography fails to give conclusive results regarding the site of delay with high specificity. Endoscopic dacryocystorhinostomy (DCR) with intubation achieves the best outcomes followed by external DCR, and bicanalicular intubation alone in such cases. Differentiation into pre-sac and post-sac delay is necessary as pre-sac delay is associated with lesser success rate. Eyelid tightening surgeries alone do not provide good long-term results. Uniformity in terms of diagnostic tests of lacrimal drainage system, ocular surface evaluation, and differentiation of pre-sac from post-sac delay is needed to formulate the diagnostic criteria for functional epiphora. [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]

BACKGROUND: The aim of this study was to evaluate the efficacy of "after washing" imaging in interpretation of dacryoscintigraphy as a functional imaging technique used in evaluation of tearing problems. MATERIALS AND METHODS: 300 nasolacrimal systems were studied. 100 µCi of technetium-99m sodium pertechnetate as drops of activity (10 µL) were placed into the inferior fornix of each eye. Dynamic images were obtained for 15 minutes in the sitting position. "After washing" phase was done by placing a drop (10 µL) of normal saline in each eye and external ocular massage for an additional 10 minutes. The imaging patterns for each eye in the first dynamic phase and after washing phase were recorded, separately. RESULTS: First dynamic phase demonstrated a sensitivity of 97.4% and specificity of 22.6%. After washing phase showed a sensitivity of 91.2% and specificity 75.5%. After washing test, the obstruction pattern changed to "patent nasolacrimal duct" or "further progression" of the radiotracer to the nasolacrimal duct in the 25.1% and 24.4% of the nasolacrimal systems, respectively. CONCLUSIONS: After washing imaging is a useful method in dacryoscintigraphy which can improve the specificity of scan for diagnosis of lacrimal duct obstruction. It can also improve the localization of obstruction level in the lacrimal systems. [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]

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.

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]

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. [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]