Functional Nasolacrimal Duct Obstruction Research Articles

Outcomes of intubation and endoscopic DCR in functional nasolacrimal duct obstruction.

To ascertain the success of lacrimal intubation and DCR in alleviating epiphora due to functional nasolacrimal duct obstruction (FNLDO). Consecutive adult patients with epiphora attending a tertiary lacrimal clinic from May 2010 to February 2021 were reviewed to identify cases with FNLDO. FNLDO was defined as epiphora with the exclusion of alternate causes of watering on clinical examination, patent lacrimal syringing, normal DCG, and post-sac delay on DSG. Epiphora resolution and improvement rates in FNLDO were compared between lacrimal intubation and endo-DCR. 23 endo-DCRs (20 patients, 65% females, mean age 68.9±12.2) and 41 intubations (29 patients, 61.2% females, mean age 65.0±14.1) performed in FNLDO were included. Resolution of epiphora was achieved in 15 of the DCR procedures (median follow-up 9 months) compared to 14 of intubations (median follow-up 10 months). Significant epiphora improvement (i.e., either improvement or resolution) was noted in 21 DCRs and 24 intubations. Seven patients undergoing intubation as the primary procedure had endo-DCR performed following the intubation. Among respondents to a phone questionnaire, 53.8% who had endo-DCR (median 69 months) and 50% that had intubation (median 28 months) reported significant improvement in epiphora. Improvement in epiphora due to FNLDO was approximately 59% in intubations, while the success of endo-DCR was higher (91%). The long-term results of these interventions warrant further investigation.

Surfactant proteins: Role in lacrimal drainage disorders

Surfactants are complex mixtures of phospholipids and proteins produced by type II alveolar cells of the lungs and play a crucial role in pulmonary physiology. Six types of surfactant proteins (SP) are known; SP-A, SP-B, SP-C, SP-D, SP-G and SP-H. The major role of SP is in reducing surface tension and various immunological functions. SP-A, SP-B, SP-C and SP-D have been demonstrated in the tear film and the epithelium of the lacrimal sac (LS) and nasolacrimal ducts (NLD). All surfactant proteins except SP-G were also isolated from the canalicular tissues. The authors hypothesize that surfactant proteins play a significant role in the pathogenesis of lacrimal drainage disorders; functional nasolacrimal duct obstruction (FNLDO) and infective dacryocystitis.

Estimation of Eyelid Pressure Using a Blepharo-Tensiometer in Patients with Functional Nasolacrimal Duct Obstruction.

Purpose To compare the eyelid pressure between patients with functional nasolacrimal duct obstruction (FNLDO) and normal controls using blepharo-tensiometer, and to evaluate the relationship between eyelid pressure and the outcomes of silicone intubation (SI) in patients with FNLDO. Study design Prospective case-control study. Methods We enrolled 36 eyes of 36 patients with suspected FNLDO who underwent SI and 36 healthy eyes of age-matched controls. One eye of each patient with FNLDO was randomly selected for analysis. The eyelid pressure was estimated using a blepharo-tensiometer and compared between the control and FNLDO groups. The relationship between eyelid pressure and clinical variables was analyzed. The outcomes of SI were assessed at 6 months after surgery using subjective and objective criteria. Results The eyelid pressure was significantly lower in the FNLDO group than in the control group (P=0.008). In the control group, the eyelid pressure was correlated with age (P<0.001) and lower eyelid laxity (P=0.016). In the FNLDO group, the eyelid pressure was only correlated with age (P<0.001). The success rate of SI for FNLDO was 69.4% (25 of 36 eyes). The eyelid pressure was higher in the surgical success subgroup than in the failure subgroup, although the difference was not statistically significant (P=0.08). Conclusions Our results suggest that the eyelid pressure measured using a blepharo-tensiometer has a diagnostic value since it is decreased in patients with FNLDO. The role of eyelid pressure as a possible predictor of the outcomes of SI for FNLDO should be investigated in further studies. This trial is registered with KCT0002828.

Aquaporin expression in the lacrimal sac of patients with primary and functional nasolacrimal duct obstruction

PurposeTo compare the expression profile of aquaporins (AQPs), a family of membrane proteins that function as selective pores in the epithelium of the lacrimal sac in patients with primary or...

Efficacy of tightening of orbicularis oculi muscle in patients with functional nasolacrimal duct obstruction

ABSTRACTPurpose: To evaluate the efficacy of tightening of lateral portion of orbicularis oculi muscle in patients with functional nasolacrimal duct obstruction (FNLDO).Methods: This is an interventional cross-section study for evaluation of effect of orbicularis oculi tightening procedure in patients with FNLDO. Patients with unexplained epiphora, open lacrimal system in syringing and evidences of lacrimal pump weakness in lacrimal scintigraphy underwent surgery. In this procedure, a stripe of preseptal and pretarsal orbicularis muscle was dissected, slightly resected and secured to the periosteum of lateral orbital rim. Each subject completed a questionnaire about the intensity of epiphora before surgery and 1, 3 and 6 months after surgery. Furthermore, fluorescein dye disappearance test (FDDT) was performed before surgery and repeated in the follow-up visits. At last visit, the pre- and post-operative data were analyzed and compared.Results: Fifteen eyes of 12 patients (5 males and 7 females) with the mean age of 56.7 years included in the study. Severity of epiphora and tearing effect on daily life were significantly improved following the operation. FDDT result was improved significantly after 1 month follow-up in all eyes (15 eyes), at 3 months follow-up in 80% of eyes (12 eyes) and at the end of the 6th month in 66.7% of eyes (10 eyes). Subjective and objective success rates were 87% and 80%, respectively. No significant complications or side-effects were observed.Conclusion: Tightening of lateral portion of preseptal and pretarsal orbicularis muscle seems an effective, safe, and easy procedure to decrease epiphora in patients with FNLDO.

New method for viewing Krehbiel flow by polymethylmethacrylate particles suspended in fluorescein solution.

To investigate the changes in the tear flow velocities caused by ageing. Ninety-nine subjects (41 men, mean age 48.3 ± 20.7 years) were recruited from the Department of Ophthalmology of the Ehime University Hospital. None of the subjects had serious abnormalities of the external surface of the eye. The Krehbiel flow of tears was determined by 40-μm polymethylmethacrylate (PMMA) beads suspended in a fluorescein sodium solution (PPF). The movement of the beads was video recorded through a slit-lamp during normal blinking. The flow of the beads was determined with a Motion ANALYZER(®) software (KEYENCE Co., Osaka, Japan). The velocity of the beads in young age, 20-40 years, middle age, 41-60 years and old age, ≥61 years, groups was determined. The equation describing the velocity (mm/second) of the PMMA particles as a function of age in the lower tear meniscus measured in the direction of the lacrimal punctum was Y = 2.49-0.04X, where Y = velocity and X = age (r(2) = 0.214; p < 0.0001). For the upper meniscus, the equation was Y = 4.83-0.05X (r(2) = 0.195, p < 0.0001). The average velocity was 0.70 ± 1.66 mm/second in the lower and 2.16 ± 1.93 mm/second in the upper tear meniscus (p < 0.0001). The particle velocity decreased significantly with increasing age, but no significant difference between the male and female groups except for the lower tear meniscus when all subjects were analysed. The PPF technique is a simple method of examining Krehbiel flow of tears and may be used for evaluating functional nasolacrimal duct obstruction quantitatively.

Surgical success rate comparison in functional nasolacrimal duct obstruction: simple lacrimal stent versus endoscopic versus external dacryocystorhinostomy

Silicone tube intubation (STI) has been known as a standard treatment modality with functional nasolacrimal duct obstruction (FNDO). Recently, dacryocystorhinostomy (DCR) is suggested for FNDO treatment. However, there are no data for comparison according to the surgical types in FNDO patients. This study aimed to compare success rates of three different lacrimal drainage surgeries in FNDO patients. Consecutive patients (153 eyes) who were treated with surgical intervention due to FNDO were analyzed. Patients were divided into three groups according to the type of surgery undertaken: STI, endoscopic DCR (Endo-DCR), and external DCR (Ext-DCR). Symptomatic improvements in epiphora were evaluated using the following scoring system: 1, complete resolution (indicative of success); 2, partial resolution; and 3, no resolution or worsening of the condition. At months 3 and 6, the Endo-DCR group had the highest success rate (84.4 and 81.3 %), but there were no statistically significant differences in epiphora scoring among the patients. Epiphora was significantly improved after surgery by week 2 in the Endo-DCR group (p = 0.0339) and by week 3 in the STI group (p = 0.0161). There were no patients in the Endo- or Ext-DCR group with a score of 3 at month 6, but 4 of 6 (3.7 %) in the STI group had score of 3 at month 6 and underwent additional DCR for epiphora. Our results suggest that Endo-DCR offers the highest success rates in FNDO treatments in terms of the rapid and complete resolution of epiphora.

Silicone Intubation for the Treatment of Epiphora in Adults With Presumed Functional Nasolacrimal Duct Obstruction

To evaluate the long-term efficacy of silicone intubation in adults with presumed functional nasolacrimal duct obstruction. This retrospective cohort study reviewed adults with unilateral or bilateral epiphora and presumed functional nasolacrimal duct obstruction treated with silicone intubation and followed for signs of treatment failure (defined as persistent epiphora or need for a secondary procedure). Median time to event (failure) after silicone intubation was calculated using Kaplan-Meier survival analysis. Analysis was conducted at the level of the individual eye, with clustering by person taken in account. Cox proportional hazards models were used and adjusted for within-subject variance using a robust sandwich estimator. Forty-four eyes from 30 patients with isolated functional nasolacrimal duct obstruction underwent silicone intubation for epiphora. Mean time to stent removal in 40 of 44 eyes was 4.0 (±4.1) months. Mean duration from the time of stent placement to last follow-up was 2.6 (±2.0) years. Overall success after silicone intubation for resolution of symptoms was 77%. Kaplan-Meier survival analysis for time to event after silicone intubation yielded a median time of 5.7 years. Extrapolated data demonstrated a 96% success rate at 2 years and 85% success rate at 3 years and predicted approximately 50% of patients to have relief of epiphora between 5 and 6 years after silicone intubation. In this study, silicone intubation has good long-term success for relief of epiphora in patients with presumed functional nasolacrimal duct obstruction. This study provides important clinical information to guide management of epiphora in adults with functional nasolacrimal duct obstruction.

Functional nasolacrimal duct obstruction – a nonexistent condition? Concepts in lacrimal dynamics and a practical course of treatment

The term functional nasolacrimal duct obstruction (FNLDO; watering with patent drainage) is misleading as it implies occluded drainage and solely nasolacrimal duct pathology. ‘Normal’ tear dynamics cannot be defined, comprising of a complex interplay of tear production, evaporation and drainage, with variability due to anatomical differences, variation in movements, environmental factors and age-related changes. FNLDO is due to several scenarios and therefore comprises an inhomogeneous group of patients for whom treatment should, logically, be sequential. First, medical measures to reduce inflammatory mediators include bathing the ocular surface and drainage system; next, lateral canthus elevation where lateral tear spillage is present; if medial spillage continues, dacryocystorhinostomy is performed; and last, secondary placement of a canalicular bypass tube will generally control symptoms where they persist after dacryocystorhinostomy.

Tear meniscus measurement in nasolacrimal duct obstruction patients with Fourier‐domain optical coherence tomography: novel three‐point capture method

Fourier-domain optical coherence tomography (FD ODT) for the evaluation of marginal tear film has not been performed in patients with watery eye or in a controlled study. We used FD OCT to evaluate the height of the lower lid tear film at three points in normal adults and compared it with two watery eye groups. We prospectively evaluated with FD OCT 25 normal subjects and 44 patients with a watery eye. Twenty-three patients with primary acquired nasolacrimal duct obstruction (PANDO) and 21 patients with functional nasolacrimal duct obstruction (FNLDO) were enrolled. Three images were obtained by three vertical FD OCT scans centred on the lower eyelid and inferior cornea, the medial limbus and the lateral limbus. The tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA) were measured with computer calipers and compared at three points between the two groups. Watery eyes have significantly greater median TMHs at three points (medial: 584 μm, central: 592 μm, lateral: 470 μm) than controls (274, 291, 205 μm, p < 0.001). Medial and central TMHs were higher than lateral TMH in controls and watery eyes. TMD and TMA also increased significantly in watery eyes (p < 0.001). There was a significant increase in central TMH compared to medial TMH in FNLDOs than in PANDOs (p < 0.05). Fourier-domain OCT is a valuable clinical tool in the evaluation of TMH in normal and watery eyes. TMH at three points can be a useful clinical parameter that investigates changes of lower tear meniscus pattern in both PANDO and FNLDO groups.

Powered endoscopic dacryocystorhinostomy with selective stenting

To compare surgical outcomes of primary powered endoscopic dacryocystorhinostomy (DCR) with selective or routine silicone stenting in anatomic and functional nasolacrimal duct obstruction (NLDO). Prospective nonrandomized cohort study with historical control group. Thirty-one consecutive primary powered endoscopic DCR procedures with selective stenting were performed for anatomic or functional NLDO. No stenting was used unless a tight Rosenmuller valve was appreciated when probing nasolacrimal system during surgery. Nasolacrimal system irrigation, dacryocystography, and lacrimal scintigraphy were used for preoperative assessment. Success was defined as absence of symptoms and patent nasolacrimal system. Comparisons were made with a historical cohort of 31 consecutive primary powered endoscopic DCR procedures with routine stenting. The overall success rate was 79% (49/62), with 96.3% (26/27) success for anatomic and 65.7% (23/35) for functional NLDO. Success rates for anatomic NLDO were 100% (8/8) with selective stenting and 94.7% (18/19) with routine stenting (P > .05). Success rates for functional NLDO were 60.9% (14/23) with selective stenting and 75% (9/12) with routine stenting (P > .05). In the selective stenting group, 2/8 of the anatomic obstructions and 8/23 of the functional obstructions required stents. Our study suggests that there is no difference in surgical outcomes of primary powered endoscopic DCR with selective or routine stenting in both anatomic and functional NLDO. We advocate a selective stenting approach for primary endoscopic DCR, whereby stents are only inserted when a tight common canaliculus opening is found during surgery.

Efficacy of dye disappearance test and tear meniscus height in diagnosis and postoperative assessment of nasolacrimal duct obstruction

To evaluate the efficacy of the fluorescein dye disappearance test (FDDT) and measurement of tear meniscus height (TMH) in the diagnosis and postoperative assessment of nasolacrimal duct obstruction (NLDO). The study group included 42 eyes of 42 patients who had a diagnosis of primary acquired nasolacrimal duct obstruction (PANDO) or functional nasolacrimal duct obstruction (FNDO) and underwent endoscopic transnasal dacryocystorhinostomy. The control group included 38 eyes of 38 people without tearing. The values of the FDDT, TMH and tearing symptom score (TSS), which was evaluated in five levels based on patients' history taking, were measured before surgery, and 1 day, 2 weeks, 1, 3 and 6 months after surgery. The values of the FDDT, TMH and TSS in the study group were compared with those of the control group. The preoperative values of the FDDT, TMH and TSS were 0.7 +/- 0.4, 0.22 +/- 0.08 mm and 1.6, respectively, in the control group and 3.0 +/- 0.8, 0.53 +/- 0.15 mm and 4.4, respectively, in the study group. These differences were statistically significant. Also, at each follow-up, the postoperative values of the FDDT and TMH decreased significantly compared to their preoperative values in the study group. The postoperative TSS decreased significantly compared to the preoperative values at each follow-up except at postoperative 1-day follow-up. There were no significant differences in the preoperative values of the FDDT, TMH and TSS between the types of NLDO. The TSS had positive correlations with the FDDT and TMH before and after surgery. These results suggest that the FDDT and TMH measurement might be effective in the diagnosis and postoperative assessment of NLDO.

Lateral Tarsal Strip Procedure and Silicone Tube Intubation on the Functional Nasolacrimal Duct Obstruction

Purpose: To compare the effects of the lateral tarsal strip procedure alone and the lateral tarsal strip procedure combined with silicone tube intubation in the treatment of functional lacrimal duct obstruction. Methods: The present study investigated 27 eyes of 20 patients underwent lateral tarsal strip procedure (LTS) alone and 29 eyes of 18 patients underwent combined lateral tarsal strip procedure and silicone tube intubation and who were diagnosed with functional lacrimal duct obstruction. The authors retrospectively reviewed patients' medical records for information including age, gender, history, follow-up period, tear meniscus height (TMH), and symptoms. Results: The average age of the LTS alone group was 60.3 years, and that of the combined groups was 65.9 years. The TMHs in the LTS only and combined operation groups were 0.62 0.23 mm and 0.62 0.19 mm before the operation and 0.43 0.20 mm and 0.26 0.09 mm after the operation, respectively. The postoperative improvement in epiphora was 74.1% after the LTS alone and 86.2% after combined LTS with silicone tube intubation. The postoperative improvement in epiphora and the operative technique of the lateral tarsal strip-canthus sparing or cantholysis were not relevant. Conclusions: Lateral tarsal strip combined with silicone tube intubation appeared useful in the treatment of epiphora patients without anatomic lacrimal duct obstruction. Determining which operative technique of lateral tarsal strip procedure should be chosen is difficult, and the preoperative syringing and snap back test may be helpful.

Effects in Lumen Width of Nasolacrimal Drainage System After Adrenergic Drug Irrigation

Purpose: The lacrimal sac and nasolacrimal duct are surrounded by a wide cavernous system of veins and arteries, and the blood vessels of the cavernous body are innnervated by the autonomic nervous system. The purpose of this study was to determine the effect of an adrenergic agonist on the lumen width of the nasolacrimal drainage system. Methods: Dacryocystography was performed on 35 patients with only epiphora and not nasolacrimal duct obstruction. The anteroposterior (AP) diameters and the oblque diameters of the nasolacrimal ducts were measured. Next, 18 patients were infused with 0.5 ml Alphagan-P (-2 adrenergic receptor agonist), 17 patients were infused with 0.5 ml DL methylephedrine hydrochloride (-1 and -2 adrenergic receptor agonist), and dacryocystography was performed again to determine the change in the lumen width of the nasolacrimal drainage system. Results: The -adrenergics caused a significant increase in the lumen width of the nasolacrimal drainage system, and the changes were more pronounced in the nasolacrimal duct than in the lacrimal sac. Although the nasolacrimal duct widening was more notable in the Alphagan-P infusion group than the DL methylephedrine hydrochloride infusion group, there was no significant statistical difference. Patients' subjective symptoms improved in both groups. Conclusions: The -adrenergics constrict the blood vessels of the cavernous body, leading to the increase in the lumen width of the nasolacrimal drainage system. This effect was more significant in the Alphagan-P infusion group. In conclusion, infusion of -adrenergics in patients with functional nasolacrimal duct obstruction can be considered as an alternative to surgical management.

Result of Silicone Tube Intubation in Patients with Epiphora Who Showing Normal Finding in Dacryocystography

Purpose: To Compare treatment results on silicone tube insertion according to the region and severity of resistance in lacrimal probing for functional nasolacrimal duct obstruction patients who complained of epiphora but are shown to be normal in lacrimal syringing and dacryocystography. Methods: A retrospective study was conducted with 40 subjects (42 eyes) who had silicone tube insertion because of functional nasolacrimal duct obstruction. A comparison was made of post-operational patient satisfaction by grading (0～3) according to the region and the severity of resistance and whether the resistance region was singular or multiple resistance regions were found on probing. Success was defined as a grade of more than one point. Results: Two eyes had no resistance regions, 28 eyes had one resistance region, and 12 eyes had more than two resistance regions on lacrimal probing. There was no statistical significance in the ranking of post-operative satisfaction among theses groups. There was also no difference among the groups for post-operative satisfaction according to obstruction site. Conclusions: Most functional nasolacrimal duct obstruction patients showed partial obstruction of the nasolacrimal duct on probing. Since functional nasolacrimal duct obstruction is not possible, we must treat patients for partial nasolacrimal duct obstruction, for wihch silicone tube insertion is thought to be effective.

Clinical Usefulness of Laser Cystectomy

Purpose: To evaluate the usefulness of laser cystectomy for the treatment of patients with dacryocystitis and sump syndrome. Methods: Thirteen patients (13 eyes) diagnosed with acute or chronic dacryocystitis, and nine patients (9 eyes) who developed sump syndrome after dacryocystorhinostomy from 2005 to 2006 underwent laser cystectomy and endonasal dacryocystorhinostomy. Results: Pain and swelling around the orbit improved immediately after the operation in patients with acute dacryocystitis, and all symptoms of sump syndrome disappeared by 1 month postoperatively. Epiphora reduced in all patients. During the follow-up period, functional nasolacrimal duct obstruction occurred in one eye and membranous obstruction developed in two eyes. In these two eyes with membranous obstruction, revisional surgery was performed successfully. No recurrence of dacryocystitis was noticed. Conclusions: Laser cystectomy with endonasal dacryocystorhinostomy is a simple and effective treatment modality for patients with dacryocystitis and sump syndrome that minimizes the risk of recurrence.

Videoreflective dacryomeniscometry in normal adults and in patients with functional or primary acquired nasolacrimal duct obstruction

Videoreflective dacryomeniscometry (VRD) for evaluation of marginal tear film has not been performed in patients with watery eye or in a controlled study. We used VRD to evaluate the height of the central marginal lower lid tear film in normal adults and compared it with two watery-eye groups and a postoperative dacryocystorhinostomy (DCR) group. Case-controlled interventional case series. We evaluated with VRD 20 subjects with normal lacrimal drainage function, 21 patients with primary acquired nasolacrimal duct obstruction (PANDO), 28 patients with functional nasolacrimal duct obstruction (FNLDO), and a postoperative group of 14 patients derived from the previous two pathologic groups. Comparison between the four groups was performed to determine statistically significant differences between tear film height. PANDO and FNLDO groups were shown to have significantly greater median tear meniscus heights ([TMH] PANDO: 620 microm, interquartile range [IQR] 453 microm; FNLDO: 731 microm, IQR 529 microm) than normal subjects (296 microm, IQR 214 microm; P < .001) and postoperative PANDO patients (265 microm, IQR 159 microm). There was no significant difference in TMH between PANDO and FNLDO groups preoperatively (P = .275). There was a reduction in median TMH postoperatively of 355 microm (P = .008) in PANDO and 360 microm (P = .068) in FNLDO. PANDO and FNLDO patients have similar preoperative TMH. In both these groups, TMH is significantly greater than in normal control subjects. Lacrimal drainage surgery substantially reduces TMH as measured using VRD in PANDO.

Orbitotemporal neurofibromatosis: Clinical features and surgical management

Purpose To classify the periorbital deformities of adult orbitotemporal neurofibromatosis (NF) and describe new clinical findings, and to recommend guidelines for surgical treatment and management of surgical complications. Design Retrospective noncomparative case series. Participants Thirty-three patients over age 16 with orbitotemporal NF. Methods Retrospective surgical case record and serial photographic review recording the laterality and the severity of periorbital involvement, the presence of complications from previous surgery, the surgical techniques undertaken, and the surgical outcome and complications. Main outcome measures Comparison of preoperative and postoperative level of deformities. Results New classification of periorbital deformities: (1) brow ptosis, (2) upper lid infiltration with ptosis, (3) lower lid infiltration, (4) lateral canthal disinsertion, and (5) conjunctival and lacrimal gland infiltration. Two patients had bilateral and 31 patients (94%) had unilateral orbitotemporal NF. All patients had upper and 19 patients (58%) had lower lid involvement. Six (18%) patients had significant brow infiltration. Fourteen (42%) patients had a dropped lateral canthus requiring surgical reattachment, 28 (85%) required anterior levator resection for ptosis, and 28 (85%) had lid-debulking surgery. New findings included severe brow infiltration, lacrimal gland involvement, and functional nasolacrimal duct obstruction. Complications from previous surgery included residual ptosis, ptosis overcorrection, poor lid contour, dry eye, corneal exposure, and upper and lower lid entropion/ectropion. Conclusions The periorbital appearance and comfort of patients with NF type 1 who have orbitotemporal NF can be significantly improved through oculoplastic surgery.

Assessment of functional nasolacrimal duct obstruction--a survey of ophthalmologists in the southwest.

The term 'functional nasolacrimal duct obstruction' describes patients with epiphora where the tear duct is partially or completely patent to syringing. Delayed tear drainage is demonstrated with a fluorescein dye disappearance test (FDDT) or lacrimal scintigraphy. A dacrocystogram is also frequently abnormal. Studies show that selected patients with epiphora because of functional nasolacrimal duct obstruction have an 80-90% success rate with open or endonasal dacryocystorhinostomy. To find out if such patients were being considered for surgery, we sent a questionnaire to all ophthalmologists in the southwest. Of the 198 questionnaires, 163 were completed and returned (82%). In the assessment of epiphora, fewer than half those questioned (41%) regularly used an FDDT and only 51% syringe patients themselves. Most did not use lacrimal scintigraphy or dacrocystography if the drainage system was patent on syringing. This survey shows that many patients with epiphora who are patent to syringing are being incompletely assessed, and hence not considered for dacrocystorhinostomy. We recommend that an FDDT is performed on all patients, syringing is carried out by experienced staff, and more radiological investigations are undertaken, so patients with a highly treatable cause of epiphora can be offered dacrocystorhinostomy.

Comparison of dacryocystography and lacrimal scintigraphy in the diagnosis of functional nasolacrimal duct obstruction

AIMIt appears from the literature that no standardised examination exists for patients with functional nasolacrimal duct obstruction. The role of dacryocystography and lacrimal scintigraphy was compared in the diagnosis and...