The value, limitations, and applications of nuclear dacryocystography

Nuclear dacryocystography is a simple, relatively harmless method of evaluating patients suspected of having abnormalities of the nasolacrimal drainage system. A drop of normal saline containing approximately 100 μ Ci of 99m Tc-pertechnetate is placed on the conjunctiva near the lateral canthus, and serial scintigrams are obtained as the pertechnetate flows along the tear strips, through the nasolacrimal drainage system, into the nasal fossa. By using a pinhole collimator with a very small aperture (1 mm), the canaliculi, the nasolacrimal sac, and the nasolacrimal duct are readily visualized. When flow is impaired, the site of obstruction can often be identified. Contrast dacryocystography provides similar information but requires the injection of contrast material directly into a canaliculus. Nuclear dacryocystography provides good functional assessment of nasolacrimal drainage but has serious shortcomings in defining pathologic anatomy. Contrast dacryocystography outlines the anatomy well but often misses minor obstructions. The two studies are complementary and together provide an effective means of evaluating the nasolacrimal drainage system.