Evaluation of Patients for Endoscopic DCR: Sac Syringing and Radionuclide Scintigraphy

  • Col Uma Patnaik
  • Maj Atul Gupta
  • Brig Ajith Nilakantan
Original Article
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Abstract

To evaluate the importance of sac syringing and radionuclide scintigraphy for pre operative work up of patients with epiphora. In this study, from the year Jan. 2013 to Jan. 2016, patients of epiphora were subjected to radionuclide scintigraphy of lacrimal apparatus in addition to sac syringing and probing. The significance of adding radionuclide scintigraphy in pre op assessment of epiphora was statistically assessed. 146 lacrimal systems were enrolled in the study. Out of them, 89 were males and 57 were females. The mean age of the patients was 42 years. Of the 146 lacrimal systems evaluated, scintigraphy detected 25 cases of common canalicular block versus 8 cases by sac syringing. Also radionuclide scintigraphy was able to detect 11 cases of functional obstruction which were patent on syringing. Results were analysed statistically. Correct diagnosis of site of obstruction is essential to predict a better surgical outcome of endoscopic DCR as it is a highly successful surgical procedure which can be done in distal NLDO only. We recommend that all patients of epiphora should undergo sac syringing as an initial test. This is a simple, inexpensive procedure which can be done as an OPD procedure in a short time. However, radionuclide scintigraphy can be added as an additional investigation to more accurately delineate site of block. It is an objective test and delineates the lacrimal system both anatomically and functionally. Also it diagnoses functional block which appears patent on syringing.

Keywords

Dacryocystorhinostomy Sac syringing Radionuclide scintigraphy Epiphora 

Notes

Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Taken by all participants of study.

References

  1. 1.
    Choi JC, Jin HR, Moon YE, Kim MS, Oh JK (2009) The surgical outcome of endoscopic dacryocystorhinostomy according to obstruction levels of lacrimal drainage systems. Clin Exp Otorhinolaryngol 2:141–144CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gauba Vinod (2008) The practice of dacryocystorhinostomy (DCR) surgery by opthalmologists in the United Kingdom. Orbit 4:279–283CrossRefGoogle Scholar
  3. 3.
    Cuthbertson FM, Webber S (2004) Assessment of functional nasolacrimal duct obstruction. Eye 18:20–23CrossRefPubMedGoogle Scholar
  4. 4.
    Wearne JW, Pitts J, Frank J, Rose GE (1999) Comparison of dacryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction. Br J Opthalmol 83:1032–1035CrossRefGoogle Scholar
  5. 5.
    Wormald PJ, Tsirbas A (2004) Investigation and endoscopic treatment for functional and anatomic obstruction of the nasolacrimal duct system. Clin Otorhinolaryngol 29:352–356CrossRefGoogle Scholar
  6. 6.
    Fergie N, Jones NS (2008) Dacryocystorhinostomy. In: Gleeson M (ed) Scott-Brown’s otolaryngology, head and neck surgery, 7th edn. Hodder Arnold, Great Britain, pp 1689–1697Google Scholar
  7. 7.
    Rose JDG, Clayton CB (1985) Scintigraphy and contrast radiography for epiphora. Br J Radiol 58:1183–1186CrossRefPubMedGoogle Scholar
  8. 8.
    Hurwitz JJ, Welham RAN, Maisey MN (1975) Radiography in functional lacrimal testing. Br J Opthalmol 59:323–331CrossRefGoogle Scholar
  9. 9.
    Hurwitz JJ, Welham RAN, Maisey MN (1976) Intubation macrodacryocystography and quantitative scintillography: the “complete” lacrimal assessment. Trans Am Acad Opthalmol Otolaryngol 81:575–582Google Scholar
  10. 10.
    Rossomondo RM, Carlton WH, Trueblood JH, Thomas RP (1972) A new method of evaluating lacrimal drainage. Arch Opthalmol 88:523–525CrossRefGoogle Scholar
  11. 11.
    MacDonald A, Burrell S (2008) Infrequently performed studies in nuclear medicine: part I. J Nucl Med Technol 36:132–143CrossRefPubMedGoogle Scholar
  12. 12.
    Amanat LA, Hilditch TE, Kwok CS (1983) Lacrimal scintigraphy. II. Its role in the diagnosis of epiphora. Br J Opthal 67:720–728CrossRefGoogle Scholar
  13. 13.
    Esfahani AF et al (2008) Assessment of the accuracy of lacrimal scintigraphy based on a prospective analysis of patients’ symptomatology. Orbit 27:237–241CrossRefGoogle Scholar
  14. 14.
    Brown M, El Gammal TA, Luxenburg MN, Eubig C (1981) The value limitations and applications of nuclear dacryocystography. Semin Nucl Med 11:250–257CrossRefPubMedGoogle Scholar
  15. 15.
    Hilditch TE, Kwok CS, Amanat LA (1983) Lacrimal scintigraphy. I. Compartmental analysis of data. Br J Opthalmol 67:713–719CrossRefGoogle Scholar
  16. 16.
    Hurwitz JJ, Welham RAN, Maisey MN (1975) Quantitative lacrimal scintillography. II. Method and physiological application. Br J Opthalmol 59:313–322CrossRefGoogle Scholar
  17. 17.
    Chung YA, Yoo IR, Oum JS, Kim SH, Sohn HS, Chung SK (2005) The clinical value of dacryoscintigraphy in the selection of surgical approach for patients with functional lacrimal duct obbstruction. Ann Nucl Med 19(6):479–483CrossRefPubMedGoogle Scholar
  18. 18.
    Kadambi V, Williams BV (1990) Functional integrity of lacrimal drainage apparatus by radionuclide dacryocystography. Indian J Opthalmol 38:24–26Google Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  • Col Uma Patnaik
    • 1
  • Maj Atul Gupta
    • 2
  • Brig Ajith Nilakantan
    • 3
  1. 1.Command HospitalPuneIndia
  2. 2.Military HospitalShillongIndia
  3. 3.Military HospitalPathankotIndia

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