Dynamic MR dacryocystography in patients with epiphora

Ophthalmology, 2002

To determine the usefulness of "routine" lacrimal sac biopsy to evaluate unsuspected neoplasm or systemic disease in patients with acquired nasolacrimal duct obstruction. Design: Noncomparative, interventional case series with histopathologic correlation. Participants: Review of charts revealed histopathologic reports on 302 specimens from 258 patients who had undergone routine dacryocystorhinostomy for clinical acquired nasolacrimal duct obstruction. Intervention: Dacryocystorhinostomy (DCR) with histopathologic evaluation of lacrimal sac. Main Outcome Measures: The following variables were extracted from the medical records: age, gender, presenting symptoms, history of predisposing conditions, lacrimal system abnormalities noted before surgery, dye disappearance test, dacryocystogram or dacryoscintillogram, appearance of the lacrimal sac during surgery, and histopathologic report of the lacrimal sac specimen. Results: Findings of histopathologic evaluation of 302 lacrimal sac specimens from 170 females and 88 males who had undergone routine DCR were reviewed. Evidence of systemic disease or neoplasia involving the lacrimal sac was present in 10 specimens. All 10 positive specimens had a grossly abnormal appearing sac at the time of surgery (n ϭ 8), a known preexisting history of systemic diseases (n ϭ 6), or both. The remaining 292 specimens showed chronic inflammation, fibrosis, or normal mucosa. Conclusions: Only patients with known preexisting systemic disease or a grossly abnormal lacrimal sac had "positive" histopathologic findings. We recommend that lacrimal sac biopsy in patients undergoing DCR should be performed only in those with a positive history for systemic disease or an abnormal-appearing lacrimal sac during surgery.

Ophthalmic Plastic and Reconstructive Surgery, 2020

American Journal of Ophthalmology, 2005

PURPOSE: Videoreflective dacryomeniscometry (VRD) for evaluation of marginal tear film has not been performed in patients with watery eye or in a controlled study. We used VRD to evaluate the height of the central marginal lower lid tear film in normal adults and compared it with two watery-eye groups and a postoperative dacryocystorhinostomy (DCR) group. • DESIGN: Case-controlled interventional case series. • METHODS: We evaluated with VRD 20 subjects with normal lacrimal drainage function, 21 patients with primary acquired nasolacrimal duct obstruction (PANDO), 28 patients with functional nasolacrimal duct obstruction (FN-LDO), and a postoperative group of 14 patients derived from the previous two pathologic groups. Comparison between the four groups was performed to determine statistically significant differences between tear film height. • RESULTS: PANDO and FNLDO groups were shown to have significantly greater median tear meniscus heights ([TMH] PANDO: 620 m, interquartile range [IQR] 453 m; FNLDO: 731 m, IQR 529 m) than normal subjects (296 m, IQR 214 m; P < .001) and postoperative PANDO patients (265 m, IQR 159 m). There was no significant difference in TMH between PANDO and FNLDO groups preoperatively (P ‫؍‬ .275). There was a reduction in median TMH postoperatively of 355 m (P ‫؍‬ .008) in PANDO and 360 m (P ‫؍‬ .068) in FNLDO. • CONCLUSIONS: PANDO and FNLDO patients have similar preoperative TMH. In both these groups, TMH is significantly greater than in normal control subjects. Lacrimal drainage surgery substantially reduces TMH as measured using VRD in PANDO. (Am J Ophthalmol 2005;139:493-497. © 2005 by Elsevier Inc. All rights reserved.) D ACRYOMENISCOMETRY (DCR) HAS BEEN USED IN

Eye, 2017

Purpose To assess the influence of dacryoscintillography (DSG) on the treatment decision for patients with epiphora and clinically patent non-functioning lacrimal systems. Methods A retrospective 3-year review. Inclusion: patients having DSG for epiphora with delayed tear clearance, lacrimal system patency on syringing, and no visible external cause for watering. On the basis of regurgitation during syringing, tear ducts were divided into freely patent (FPr20%) or stenosed. The DSG results were examined for correlation with symptoms and clinical examination, the influence on decision to proceed to dacryocystorhinostomy (DCR), and the ability to predict the surgical outcome. Results A total of 242 eyes were examined. The clinical diagnosis was FP in 45.5%, nasolacrimal duct stenosis (NLDS) in 26.4%, and other in 3.3%. The DSG was normal in 30.9% of FP and 18.7% of NLDS eyes. Of the asymptomatic eyes, 46.7% had an abnormal DSG. DSG sensitivity was 73.6% and specificity 53.3%. There was no significant difference in DSG results in those with FP or NLDS. DCR was recommended in 39.1% of the symptomatic eyes with abnormal DSG. DCR surgery was considered inappropriate in all 46 eyes with normal DSG. DCR was successful in 76.5%, however, the DSG result did not affect the success of surgery. Conclusion DSG has severe limitations due to lack of correlation with symptoms and clinical examination, inability to separate lacrimal duct narrowing from lacrimal pump function, and inability to predict the results of surgery. DSG can at best provide limited guidance on whether to proceed to DCR surgery.

American Journal of Roentgenology, 2002

Folia Morphologica, 2013

Background: Asymmetric lacrimal flow occurs in females more than males. We hypothesised that the normal lacrimal drainage system (LDS) may show subtle left-right asymmetry in morphometry when imaged on dacryocystography (DCG). Materials and methods: We retrospectively reviewed 60 normal bilateral LDSs. Images were analysed for 7 parameters: (1) combined length of either the superior or inferior canaliculus plus common canaliculus, width of proximal and distal NLD. We tested the effect of independent variables (age, gender, and side) on each dependent variable (length, width, or angle) using regression analysis. We used a Student t-test for independent samples to statistically compare bilateral LDSs. Results: Patient median age was 62 years, and male:female ratio was 27:73. Mean dimensions and angles for all LDSs were: (1) 14.5 mm, (2) 57°, (3) 11.6 mm, (4) 2.1 mm, (5) 20.7 mm, (6) 1.4 mm, and (7) 1.8 mm. No independent variable affected variation in length, width, or angle. No significant difference emerged between dimensions of right and left LDSs in both sexes. Conclusions: A degree of affective lateralisation in the brain is known to result in lacrimal flow asymmetry after mood manipulation. We show that this is not reflected in LDS anatomy. Moreover, our detailed morphometric data can aid in therapeutic planning of LDS luminal procedures, especially when DCG images of one LDS are used as a roadmap for contralateral interventions. (Folia Morphol 2013; 72, 2: 137-141)

Veterinary Radiology & …, 2004

Computed tomography-dacryocystography (CT-DCG) was used to evaluate the nasolacrimal system in four patients (three dogs and one horse) that were admitted for evaluation of chronic epiphora, facial swelling, or facial trauma. The four patients are ...

the egyptian journal of histology, 2021

Purpose: To correlate the clinical data to the histopathological characteristics of lacrimal sac and bone specimens in adult patients undergoing indicated external transcutaneous dacryocystorhinostomy surgery (DCR) for primary acquired nasolacrimal duct obstruction (PANDO) in order to determine the important clinical parameters that may necessitate selective lacrimal biopsy in certain situations.Methods: This is non-comparative, non-controlled descriptive case series study with histopathological correlation. Lacrimal sac and bone specimens for each case were collected during DCR from consecutive patients with PANDO presenting to the outpatient clinic of “Ain Shams University” hospitals, then sent for histopathological examination.Results: Fifty-one lacrimal specimens were obtained from a total of 49 consecutive patients who underwent external DCR for clinical PANDO at the time interval from March 2018 to March 2020 at “Department of Ophthalmology, Ain Shams University” operating the...

British Journal of Ophthalmology, 2005

Objective: To determine whether routine biopsy of the lacrimal sac wall at dacryocystorhinostomy (DCR) is indicated. Methods: A prospective study and literature review. In 193 consecutive endoscopic DCRs performed on 164 patients (108 females and 56 males) part of the medial wall of the lacrimal sac was sent for histological examination. The mean age of the patients was 64 years with a range of 2.5-89 years. Previous reported series were reviewed. Results: Of the 193 specimens, 44 (23%) showed normal histology, 146 (76%) showed varying degrees of non-specific chronic inflammation, and three (1.2%) showed specific pathology. Of the three specimens that showed specific pathology two showed sarcoidosis and one showed transitional cell papilloma. The two specimens with sarcoidosis were obtained from one patient who underwent bilateral surgery. In this and the six previous reported series only seven of 1294 specimens (0.5%) showed specific pathology, which was definitely not suspected preoperatively or intraoperatively, and only one of these (0.08%) was found to be malignant (a lymphoma). Conclusions: Biopsy of the lacrimal sac wall at DCR is not indicated routinely and is only indicated if there is a reason to suspect pathology other than chronic inflammation preoperatively or intraoperatively. L acrimal obstruction may be proximal (single or common canalicular obstruction), distal (sac or duct obstruction), functional, or a combination of these. 1 A diagnosis of functional obstruction is made when syringing and probing demonstrate no obstruction of the lacrimal system and yet the more physiological investigation of scintigraphy demonstrates reduced passage of radiolabelled tracer through the lacrimal system.

The main purpose of this paper is to provide the information about the incidence and types of pathology of secondary acquired obstructions of the lacrimal excretory outflow system caused by primary lacrimal sac non-neoplastic and neoplastic lesions. After a thorough literature search, 17 case-control studies were found and selected, data were extracted and categorized, to evaluate specific lacrimal sac pathology mimicking inflammation. A total of 3865 histopathologically examined lacrimal sac wall biopsy specimens from 3662 patients, taken during dacryocystorhinostomy for clinically presumed primary chronic dacryocystitis, were analyzed. The most common reported histopathological finding was non-specific chronic inflammation with or without fibrosis (94.15% of cases). Lacrimal sac-specific pathologies were present in 226 (5.85%) cases. Unsuspected lacrimal sac-specific pathologies were present in 55/226 (24.34%) cases. Almost 45% of primary lacrimal sac malignant neoplasms were not suspected, preoperatively and intraoperatively. Tumor-like lesions of the lacrimal sac were the most common pathology found: (1) lacrimal stones-dacryoliths, (2) pyogenic granuloma, (3) granulation tissues, (4) reactive lymphoid hyperplasia, and (5) lacrimal sac-specific inflammation (Wegener’s granulomatosis and sarcoidosis). Neoplastic pathology was found in 55/3865 (1.42%) lacrimal sac wall biopsy specimens; of those, malignant cases were 2.24 times more frequent than benign. Lymphoma was the most common preoperatively unsuspected or intraoperatively unexpected neoplastic pathology. This analysis of the relevant literature highlights the value of routine lacrimal sac biopsy during surgery for clinically presumed primary acquired nasolacrimal duct obstruction.