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Clinical Evaluation and Imaging of Lacrimal Drainage Obstruction

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The Lacrimal System

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Abstract

Obstruction of the lacrimal drainage system requires careful clinical and sometimes radiographic evaluation to determine the etiology. The site of obstruction, anywhere from the puncta to the nasolacrimal ostium in the inferior nasal meatus must be accurately determined in order to offer appropriate management. Tearing symptoms can also result from, or be exacerbated by, dysfunction of the tear drainage pump mechanism due to eyelid laxity or punctal dystopia. This chapter reviews the various clinical, ultrasound, X-ray, CT, and MRI studies that can help determine the causes of epiphora and guide the clinician toward an appropriate therapeutic plan.

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References

  1. Dutton JJ. Atlas of clinical and surgical orbital anatomy. London: Elsevier; 2011. p. 165–74.

    Book  Google Scholar 

  2. Dutton JJ. Diagnostic tests and imaging techniques. In: Linberg JV, editor. Lacrimal surgery. New York: Churchill Livingstone; 1988. p. 19–48.

    Google Scholar 

  3. Mimura T, Usul T, Yamamoto H, et al. Conjunctivochalasis and contact lenses. AJNR Am J Ophthalmol. 2009;148:20–2.

    Article  Google Scholar 

  4. Mimura T, Yamagami S, Usul T, et al. Changes of conjunctivochalasis with age in a hospital-based study. Am J Ophthalmol. 2009;147:171–7.

    Article  PubMed  Google Scholar 

  5. Li QS, Zhang XR, Zou HD, et al. Epidemiologic study of conjunctivochalasis in populations equal or over 60 years old in Caoyangxincun community of Shanhai. Zhonghua Yan Ke Za Zhi. 2009;45:793–8.

    PubMed  Google Scholar 

  6. Knijnik D. Tearing and eyelid laxity with no ectropion: is tarsal strip always effective? Arq Bras Oftalmol. 2006;69:37–9.

    Article  PubMed  Google Scholar 

  7. Narayanan K, Barnes EA. Epiphora with eyelid laxity. Orbit. 2005;24:201–3.

    Article  PubMed  Google Scholar 

  8. Vick VL, Holds JB, Hartstein ME, Massry GG. Tarsal strip procedure for the correction of tearing. Ophthal Plast Reconstr Surg. 2004;20:37–9.

    Article  PubMed  Google Scholar 

  9. Detorakis ET, Zissimopoulos A, Katernellis G, et al. Lower eyelid laxity in functional acquired epiphora: evaluation with quantitative scintigraphy. Ophthal Plast Reconstr Surg. 2006;22:25–9.

    Article  PubMed  Google Scholar 

  10. Bukhari A. Prevalence of punctal stenosis among ophthalmology patients. Middle East Afr J Ophthalmol. 2009;16:85–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Billing K, Karagiannis A, Selva D. Punctal-canalicular stenosis associated with mitomycin-C for corneal epithelial dysplasia. Am J Ophthalmol. 2003;136:746–7.

    Article  PubMed  Google Scholar 

  12. Eiseman AS, Flanagan JC, Brooks AB, et al. Ocular surface, ocular adnexal, and lacrimal complications associated with the use of systemic 5-fluorouracil. Ophthal Plast Reconstr Surg. 2003;19:216–24.

    Article  PubMed  Google Scholar 

  13. Esmaeli B, Valero V, Ahmani MA, Booser D. Canalicular stenosis secondary to doxetaxel (taxotere): a newly recognized side effect. Ophthalmology. 2001;108:994–5.

    Article  PubMed  CAS  Google Scholar 

  14. Schirmer O. Studien zur physiology und pathology der tranenabsonderung und tranenabfuhr. Graefes Arch Clin Exp Ophthalmol. 1903;56:197–291.

    Article  Google Scholar 

  15. Karampatakis V, Karamitsos A, Skriapa A, Pastiadis G. Comparison between normal values of 2- and 5-minutes Schirmer test without anesthesia. Cornea. 2010;29:497–501.

    Article  PubMed  Google Scholar 

  16. Zappia RJ, Milder B. Lacrimal drainage function. The fluorescein dye disappearance test. Am J Ophthalmol. 1972;74:160–2.

    Article  PubMed  CAS  Google Scholar 

  17. Wright MM, Bersani TA, Frueh BR, Musch DC. Efficacy of the primary dye test. Ophthalmology. 1989;96:481–3.

    Article  PubMed  CAS  Google Scholar 

  18. Flach A. The fluorescein appearance test for lacrimal obstruction. Ann Ophthalmol. 1979;11:237–42.

    PubMed  CAS  Google Scholar 

  19. Hornblass A. A simple taste test for lacrimal obstruction. Arch Ophthalmol. 1973;90:435–6.

    Article  PubMed  CAS  Google Scholar 

  20. Lipsius EI. Sodium saccharin for testing the patency of the lacrimal passages. Am J Ophthalmol. 1957;43:114–5.

    Article  PubMed  CAS  Google Scholar 

  21. Beigi B, Uddin JM, McMillan TF, Linardos E. Inaccuracy of diagnosis in a cohort of patients on the waiting list for dacryocystorhinostomy when the diagnosis was made by only syringing the lacrimal system. Eur J Ophthalmol. 2007;17:485–9.

    PubMed  CAS  Google Scholar 

  22. Francis IC, Chan DG, Papalkar D, et al. Videreflactive dacryomeniscometry in normal adults and in patients with functional or primary acquired nasolacrimal duct obstruction. Am J Ophthalmol. 2005;139:493–7.

    Article  PubMed  Google Scholar 

  23. Burkat CN, Lucarelli MJ. Tear meniscus level as an indicator of nasolacrimal obstruction. Ophthalmology. 2005;112:344–8.

    Article  PubMed  Google Scholar 

  24. Al-Faky YH. Anatomic utility of ultrasound biomicroscopy in the lacrimal drainage system. Br J Ophthalmol. 2011;95:1446–50.

    Article  PubMed  Google Scholar 

  25. Dutton JJ. Standardized echography in the diagnosis of lacrimal drainage dysfunction. Arch Ophthalmol. 1989;107:1010–2.

    Article  PubMed  CAS  Google Scholar 

  26. Rochels R, Lieb W, Nover A. Echographic diagnosis in diseases of the efferent tear ducts. Klin Monbl Augenheilkd. 1984;185:243–9.

    Article  PubMed  CAS  Google Scholar 

  27. Montanara A, Mannino G, Contestabile M. Macrodacryocystography and echography in diagnosis of disorders of the lacrimal pathways. Surv Ophthalmol. 1983;28:33–41.

    Article  PubMed  CAS  Google Scholar 

  28. Repp DJ, Burkat CN, Lucarelli MJ. Lacrimal excretory system concretions: canalicular and lacrimal sac. Ophthalmology. 2009;116:2230–5.

    Article  PubMed  Google Scholar 

  29. Tost F, Bruder R, Clemens S. 20-MHz ultrasound of presaccular lacrimal ducts. Ophthalmologe. 2002;99:25–8.

    PubMed  CAS  Google Scholar 

  30. Tobias S, Pavlidis M, Busse H, Thanos S. Presurgical and postsurgical assessment of lacrimal drainage dysfunction. Am J Ophthalmol. 2004;138:764–71.

    Article  Google Scholar 

  31. Stupp T, Pavidis M, Busse H, Thanos S. Presurgical and postsurgical ultrasound assessment of lacrimal drainage dysfunction. Am J Ophthalmol. 2004;138:764–71.

    Article  PubMed  Google Scholar 

  32. Iba GB, Hanafee WN. Distention dacryocystography. Radiology. 1968;90:1020–2.

    Article  PubMed  CAS  Google Scholar 

  33. Galloway JE, Kavic TA, Raflo GT. Digital subtraction macrodacryocystography. Ophthalmology. 1984;91:956–62.

    Article  PubMed  CAS  Google Scholar 

  34. Malik SRK, Gupta AK, Chaterjee S, et al. Dacryocystography of normal and pathological lacrimal passages. Br J Ophthalmol. 1969;53:174–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  35. Lee MJ, Kyung HS, Han MH, et al. Evaluation of lacrimal tear drainage mechanism using dynamic fluoroscopic dacryocystography. Ophthal Plast Reconstr Surg. 2011;27:164–7.

    PubMed  Google Scholar 

  36. Freitag S, Woog JJ, Kousoubris PD, Curtin HD. Helical computed tomography dacryocystography with three-dimensional reconstruction. Ophthal Plast Reconstr Surg. 2002;18:121–32.

    Article  PubMed  Google Scholar 

  37. Bonnet F, Ducasse A, Marcus C, Hoeffel C. CT dacryocystography: normal findings and pathology. J Radiol. 2009;90:1685–93.

    Article  PubMed  CAS  Google Scholar 

  38. Wilhelm KE, Rudorf H, Greschus S, et al. Cone-beam computed tomography (CBCT) dacryosystography for imaging of the nasolacrimal duct system. Clin Neuroradiol. 2009;19:283–91.

    Article  Google Scholar 

  39. Frances IC, Kappagoda MB, Cole IE, Bank L, Dunn GD. Computed tomography of the lacrimal drainage system: retrospective study of 107 cases of dacryostenosis. Ophthal Plast Reconstr Surg. 1999;15:217–26.

    Article  Google Scholar 

  40. Glatt HJ. Evaluation of lacrimal obstruction secondary to facial fractures using computed tomography or computed tomographic dacryocystography. Ophthal Plast Reconstr Surg. 1996;12:284–93.

    Article  PubMed  CAS  Google Scholar 

  41. Debnam JM, Esmaeli B, Ginsberg LE. Imaging characteristics of dacryocystocele diagnosed after surgery for sinonasal cancer. Am J Neuroradiol. 2007;28:1872–5.

    Article  PubMed  CAS  Google Scholar 

  42. Udhay P, Noronha OV, Mohan RE. Helical computed tomographic dacryocystography and its role in the diagnosis and management of lacrimal drainage system blocks and medial canthal masses. Indian J Ophthalmol. 2008;56:31–7.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ashenhurst M, Jaffer N, Hurwitz JJ, et al. Combined computed tomography and dacryocystography for complex lacrimal problems. Can J Ophthalmol. 1991;26:27–31.

    PubMed  CAS  Google Scholar 

  44. Amrith S, Goh PS, Wang SC. Tear flow dynamics in the human nasolacrimal ducts—a pilot study using dynamic magnetic resonance imaging. Graefes Arch Clin Exp Ophthalmol. 2005;243:127–31.

    Article  PubMed  Google Scholar 

  45. Goldberg RA, Heinz GW, Chiu L. Gadolinium magnetic resonance imaging dacryocystography. Am J Ophthalmol. 1993;115:738–41.

    Article  PubMed  CAS  Google Scholar 

  46. Karagulle T, Erden A, Erden I, et al. Nasolacrimal system: evaluation with gadolinium-enhanced MR dacryocystography with a three-dimensional fast spoiled gradient recalled technique. Eur Radiol. 2002;12:2343–8.

    Article  PubMed  Google Scholar 

  47. Rubin PA, Bilyk JR, Shore JW, et al. Magnetic resonance imaging of the lacrimal drainage system. Ophthalmology. 1994;101:235–43.

    Article  PubMed  CAS  Google Scholar 

  48. Cubuk R, Tasali N, Aydin S, Saydam B, Sengor T. Dynamic MR dacryocystography in patients with epiphora. Eur J Radiol. 2010;73:230–3.

    Article  PubMed  CAS  Google Scholar 

  49. Hoffmann KT, Anders N, Hosten N, et al. High resolution functional magnetic resonance tomography with Gd-DTPA eye drops in diagnosis of lacrimal apparatus diseases. Ophthalmologe. 1998;95:542–8.

    Article  PubMed  CAS  Google Scholar 

  50. Kirchhof K, Hähnel S, Jansen O, et al. Gadolinium-enhanced magnetic resonance dacryocystography in patients with epiphora. J Comput Assist Tomogr. 2000;24:327–31.

    Article  PubMed  CAS  Google Scholar 

  51. Manfrè L, de Maria M, Todaro E, et al. MR dacryocystography: comparison with dacryocystography and CT dacryocystography. AJNR Am J Neuroradiol. 2000;21:1145–50.

    PubMed  Google Scholar 

  52. Weber AL, Rodrigues-De Velasquez A, Lucarelli MJ, Cheng HM. Normal anatomy of the lacrimal sac and duct: evaluated by dacryocystography, computed tomography and MR imaging. Neuroimaging Clin N Am. 1996;6:199–217.

    PubMed  CAS  Google Scholar 

  53. Rossomondo RM, Carlton WH, Trueblood JH, et al. A new method of evaluating lacrimal drainage. Arch Ophthalmol. 1972;88:523–5.

    Article  PubMed  CAS  Google Scholar 

  54. Carlton WH, Trueblood JH, Rossomondo RM. Clinical evaluation of microscintigraphy of the lacrimal drainage apparatus. J Nucl Med. 1973;14:89–92.

    PubMed  CAS  Google Scholar 

  55. Jager PL, Mansour K, Vrakkink-de Zoete H, et al. Clinical value of dacryoscintigraphy using a simplified analysis. Graefes Arch Clin Exp Ophthalmol. 2005;243:1134–40.

    Article  PubMed  CAS  Google Scholar 

  56. Wearne MJ, Pitts J, Frank J, et al. Comparison of dacryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction. Br J Ophthalmol. 1999;83:1032–5.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  57. Jabbour J, Van der Wall H, Katelaris L, et al. Quantitative lacrimal scintigraphy in the assessment of epiphora. Clin Nucl Med. 2008;33:535–41.

    Article  PubMed  Google Scholar 

  58. Amanat LA, Hilditch TE, Kwok CS, et al. Lacrimal scintigraphy II. Its role in the diagnosis of epiphora. Br J Ophthalmol. 1983;67:720–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  59. Fard-Esfahani A, Tari AS, Saghari M, et al. Assessment of the accuracy of lacrimal scintigraphy based on a prospective analysis of patients’ symptomatology. Orbit. 2008;27:237–41.

    Article  PubMed  Google Scholar 

  60. Hilditch TE, Kwok CS, Amanat LA. Lacrimal scintigraphy I. Compartmental analysis of data. Br J Ophthalmol. 1983;67:713–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  61. Palaniswamy SS, Subramanyam P. Dacryoscintigraphy: an effective tool in the evaluation of postoperative epiphora. Nucl Med Commun. 2012;33:262–7.

    Article  PubMed  Google Scholar 

  62. Putterman AM. Dacryocystography with occluded common canaliculus. Am J Ophthalmol. 1973;76:1010–2.

    Article  PubMed  CAS  Google Scholar 

  63. Cohen SW, Sherman M, Schwartz GG, et al. Lacrimal outflow patency demonstrated by chemiluminescence. Arch Ophthalmol. 1980;98:126–7.

    Article  PubMed  CAS  Google Scholar 

  64. Vettese T, Hurwitz JJ. Toxicity of the chemiluminescent material Cyalume in anatomic assessment of the nasolacrimal system. Can J Ophthalmol. 1983;18:131–5.

    PubMed  CAS  Google Scholar 

  65. Raflo GT, Chart P, Hurwitz JJ. Thermographic evaluation of the human lacrimal drainage system. Ophthalmic Surg. 1982;13:119–24.

    PubMed  CAS  Google Scholar 

  66. Kim C, Lee MJ, Khwarg SI. Voluntary blinking and use of 0.25 % dye on fluorescein dye disappearance test. Can J Ophthalmol. 2013;48:99–103.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, University of North Carolina, 5111 Bioinformatics Building, CB 7040, Chapel Hill, NC, 27599-7040, USA

    Jonathan J. Dutton M.D., Ph.D.

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  1. Jonathan J. Dutton M.D., Ph.D.
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Correspondence to Jonathan J. Dutton M.D., Ph.D. .

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Editors and Affiliations

  1. Assistant Professor, Section Director of Oculoplastic and Reconstructive Surgery, Department of Ophthalmology, Eyelid and Facial Plastic Surgery, Private Practice, Glenview, IL, USA & Rush University Medical Center, Chicago, Illinois, USA

    Adam J. Cohen

  2. Opthalmic Consltants, Sarasota, Florida, USA

    Michael Mercandetti

  3. Department of Ophthalmology, Weill Medical College of Cornell, New York, New York, USA

    Brian Brazzo

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Dutton, J.J. (2015). Clinical Evaluation and Imaging of Lacrimal Drainage Obstruction. In: Cohen, A., Mercandetti, M., Brazzo, B. (eds) The Lacrimal System. Springer, Cham. https://doi.org/10.1007/978-3-319-10332-7_7

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  • DOI: https://doi.org/10.1007/978-3-319-10332-7_7

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