Evaluation of Dacroscintigraphy and Dacrocystography in Assessment of Nasolacrimal Drainage Apparatus in Patients of Chronic Epiphora

Aim : To study the effectiveness of the two procedures Dacrocystography and Dacryoscintigraphy for diag- nosing of blockage of Nasolacrimal Duct system. Methods and Material : The prospective study included 33 patients with 40 eyes and was carried out for 1 year at our ter- tiary care teaching hospital. Patient with unilateral/bilateral epiphora were selected for both the tests after screening them for nasolacrimal duct system block by sac syringing. Other causes of epiphora were excluded. Nuclear scintigraphy using technetium 99 DTPA was performed followed by dacrocystography using water soluble dye in all patients. Results: Scintigraphy showed 92.68% positive results and 7.31 % negative (false negative) for the block and dacrocystogra- phy gave 78.04% positive and 21.95 % negative(false negative). Conclusion: Nuclear scintigraphy can be used effectively as a valuable diagnostic tool for diagnosing functional and mechanical obstruction in patients before doing a Dacrocystorhinostomy and can be used as first line of investigation for diagnosis. Introduction: Tearing process was first studied with radioisotopes in 1973. Epiphora is the presenting complaint of patients with block- age of nasolacrimal duct system. Both ophthalmologists and otorhinolaryngologists deal with the diagnosis and treatment of nasolacrimal duct block. The surgical intervention is a Dac- rocystorhinostomy in case of nasolacrimal duct block, done endoscopically by an Otorhinolaryngologist and externally by an ophthalmologist. There are various tests performed to diagnose the level of nasolacrimal duct block such as fluorescien dye test, dacro - cystography, nuclear lacrimal scintigraphy , CTscan and MRI. It is not necessary to conduct the whole battery of tests to diagnose the level of Nasolacrimal duct system block. Clini- cally reflux from same punctum or opposite punctum on sac syringing indicates blockage of nasolacrimal duct system. Dacrocystography gives anatomical orientation of the nasol- acrimal duct system whereas scintigraphy shows the 'func- tional integrity' of the nasolacrimal duct system. In our study we have attempted to study the effectivity of the following procedures sac syringing, dacrocystography and dacroscintigraphy in diagnosing correctly the condition of nasolacrimal duct blockage and thus treat patient effectively. Material and methods: Ours was a prospective study of one year involving 33 pa- tients who attended the ENT OPD in a tertiary care hospital with the complaint of watering of eyes (unilateral / bilateral). Inclusion criteria: Patients with epiphora with normal lid posi- tion and no other ocular disease were included in the study. The study also included patients with congenital dacrocys- titis. Patient with failure of dacrocystorhinostomy surgery were also included. Exclusion criteria: Patient with ectropion, other ocular conditions resulting in epiphora and pregnant females were excluded.