Purpose

Epiphora is a common complaint in oculoplastic practice. determining the level
and functional significance of lacrimal drainage obstruction can be challenging.
Clinical examination may provide discordant findings, particularly in functional or
partial obstruction. Lacrimal scintigraphy is a physiologic test of tear drainage;
Its impact on real-world clinical decision-making remains incompletely
defined.
Our aim was to evaluate whether lacrimal scintigraphy influences management
decisions in patients with epiphora.

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Methods

A retrospective study which included patients who underwent lacrimal scintigraphy
for epiphora at The Hillel-Yaffe medical center.
Data included:
• Demographics
• Clinical findings
• Scintigraphy results
• Initial management plan
• Final management decision after scintigraphy
Primary outcome was the proportion of cases in which scintigraphy findings resulted in a change in the planned management.

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Results

A total of 31 patients, 62 eyes were included. The mean age was 67 years (range 42-
86). Scintigraphy findings demonstrated normal drainage in 32%, delayed drainage in 8%
and complete obstruction in 60%. Based on clinical assessment alone, the initial management plan was conservative
treatment in 48%, lacrimal surgery in 18% and further observation/investigation in
34%.
Following lacrimal scintigraphy, the management plan changed in 52% of cases.
Most common changes included: recommendation for surgery in previously
conservatively managed patients in 50%, avoidance of planned surgery in 31% and
change in surgical approach in 19%. In the remaining 48% of cases, scintigraphy findings supported the original
decision.

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Conclusion

Lacrimal scintigraphy influenced decision-making in a meaningful proportion
of patients. Scintigraphy may provide additional functional
information that can refine management, particularly in cases with discordant
clinical findings or suspected functional obstruction. Selective use of lacrimal
scintigraphy may assist in optimizing patient selection for lacrimal surgery and avoiding unnecessary procedures.

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Additional Authors

First name	Last name	Base Hospital / Institution
Shay	Keren	HYMC
Polina	Isakovich-Albagly	HYMC
Yara	Karawani	HYMC

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