1Department of Ophthalmology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
2Department of Ophthalmology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
3Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Introduction: This study was done to determine the site of obstruction in lacrimal drainage system in Asian patients suffering from epiphora and to determine the transit time taken for the tracer material to reach the lacrimal sac and the nasal cavity. Methods:Dacryoscintigraphy was performed using radionuclide technetium-99m pertechnetate (99mTc) in 34 patients suffering from unilateral or bilateral epiphora and in 3 cases of post-operative dacryocystorhinostomy. The site of obstruction was noted during the dynamic scintigraphy procedure. The time taken for the tracer material to reach the lacrimal sac in all the eyes and the nasal cavity in the eyes with patency of nasolacrimal duct was determined. Results:Complete obstruction of nasolacrimal duct (NLD) was noted in all 22 unilateral cases. However, in 4 of the contralateral asymptomatic eyes in these patients complete obstruction of NLD was detected. Out of 12 bilateral cases, complete obstruction of NLD was noted in both eyes in 4 cases, and in one eye only in 8 cases. There was partial obstruction of NLD in the other eye in these 8 patients. The mean transit time taken for the tracer material to reach the lacrimal sac was 8 seconds (range 5 – 14 seconds) and to the nasal cavity was 6 minutes 20 seconds (range 2 minutes 16 seconds – 12 minutes). Conclusion:This non-invasive procedure helps in the diagnosis of partial obstruction of NLD which can be missed by syringing procedure. The time taken for the tears to drain into the nasal cavity can also be measured in eyes with patent nasolacrimal duct by this procedure.
Ayati NK1, Malekshahi RG, Zakavi SR, Dabbagh Kakhki VR, Aryana K, Sadeghi R. Systemic absorption of Tc-99m-pertechnetate during dacryoscintigraphy: a note of caution. Orbit. 2010 Oct;29(5):269-70.
Robertson JS, Brown ML, Colvard DM. Radiation absorbed dose to the lens in dacryoscintigraphy with 99mTcO4-. Radiology. 1979 Dec;133(3 Pt 1):747-50.
Amanat LA, Wraight EP, Watson PG, Hawkins TD. Role of lacrimal scintigraphy and subtraction macrodacryocystography in the management of epiphora. Br J Ophthalmol. 1979 Jul;63(7):511-9.
Heyman S, Katowitz JA, Smoger B. Dacryoscintigraphy in children. Ophthalmic Surg. 1985 Nov;16(11):703-9.
Brizel HE, Sheils WC, Brown M. The effects of radiotherapy on the nasolacrimal system as evaluated by dacryoscintigraphy. Radiology. 1975 Aug;116(02):373-81.
Sagili S, Selva D, Malhotra R. Lacrimal scintigraphy: "interpretation more art than science". Orbit. 2012 Apr;31(2):77-85.
Gholamrezanezhad A, Fard-Esfahani A, Sadeghi-Tari A, Mirpour S, Saghari M, Eftekhari M, Fallahi B, Beiki D, Poormoslemi A, Tarbiat A. Quantitative assessment of dacryoscintigraphic images in the evaluation of epiphora. Orbit. 2007 Dec;26(4):229-35.
Amanat LA, Hilditch TE, Kwok CS. Lacrimal scintigraphy. II. Its role in the diagnosis of epiphora. Br J Ophthalmol. 1983 Nov;67(11):720-8.
Brown M, El Gammal TA, Luxenberg MN, Eubig C. The value, limitations, and applications of nuclear dacryocystography. Semin Nucl Med. 1981 Oct;11(4):250-7.
Wearne MJ, Pitts J, Frank J, Rose GE. Comparison of dacryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction. Br J Ophthalmol. 1999 Sep;83(9):1032-5.
Al-Ghamadi AA, El-Saban K. Clinical values of the lacrimal scintigraphy parameters in diagnosis of epiphora: comparison to dacryocystography. Med J Cairo Univ. 2011;79(2):13-22.
Amanat LA, Hilditch TE, Kwok CS. Lacrimal scintigraphy. III. Physiological aspects of lacrimal drainage. Br J Ophthalmol. 1983 Nov;67(11):729-32.