Evaluation of Distal Occlusions accompanying Punctal Stenosis using Radionuclide Imaging in patients with Unilateral Epiphora

Abstract

Objective: Our objective was to evaluate distal occlusions accompanying punctal stenosis, which can lead to impaired nasolacrimal drainage in patients with punctal stenosis, using radionuclide imaging. Material and Methods: Our study enrolled 42 patients who had unilateral punctal stenosis and experienced epiphora on the same side. None of the patients had previously undergone surgical intervention for this condition. Ophthalmological examination results were normal on the unaffected side. Dacryoscintigraphy was performed bilaterally, and specific regions of interest were identified. The scintigraphic images were assessed quantitatively and qualitatively by two nuclear medicine specialists. Evaluation between the nuclear medicine specialists was conducted using the McNemar Bowker test and the Kappa test. Results: Eighty-one percent (34) of the patients were female. The mean age of the patients was 68.23±9.67 years. In patients with punctal stenosis, the punctal area exhibited edematous features. The lacrimal drainage pathway from the punctum was assessed by two nuclear medicine specialists using two different methods. In the visual quantitative evaluation to determine the localization of the stenosis, there was a low to moderate agreement between the two observers (p=0.018, kappa value=0.252). In the quantitative evaluation, there was excellent agreement between the observers (p=0.0001, kappa value=1). Conclusion: Dacryoscintigraphy is preferred as an imaging method due to its non-invasive nature that does not disturb the physiological processes. It offers advantages such as lower radiation exposure and higher patient compliance compared to dacryocystography. However, it should be noted that the anatomical correlation in dacryoscintigraphy is relatively low compared to radiological methods. By incorporating quantitative data into the visual assessment of dacryoscintigraphy, it may be possible to enhance anatomical correlation and improve observer agreement, particularly in patients presenting with a combination of functional and anatomical obstructions.