Abstract Listings 2025

Purpose

To evaluate the diagnostic potential of CTDCI in assessing normal and obstructed lacrimal drainage systems.

Methods

This was a prospective interventional study. A total of 33 normal lacrimal system from 22 patients were assessed. Among these, 6 lacrimal pathways from 3 patients with unilateral obstruction were analyzed separately. CT images were obtained after instillation of iodinated contrast (iopromide 300 mg/mL), preceded by hydrostatic compression of the lacrimal sac. Three drops were instilled per eye, one every 2 minutes.

Results

Visualization rates were: canaliculi in 21%, lacrimal sac in 90.9%, and nasolacrimal duct in 100% of normal sides. Irregularities in the sac and duct were noted in 57.6% and 66.7% respectively. Intraluminal air was present in 36.4%. In a series of unilateral distal lacrimal obstructions, three distinct patterns were observed. In the first case, dacryocystography revealed contrast retention in the lacrimal sac without progression into the nasolacrimal duct on the affected side, while the contralateral side showed complete contrast passage through the lacrimal drainage system. The second case, evaluated endoscopically, exhibited contrast throughout the system, but intraoperative inspection identified “sandpaper-like” resistance at the valve of Krause. No contrast was observed on the opposite side. The third patient, who underwent external dacryocystorhinostomy, demonstrated sac dilatation with contrast interruption at the sac–nasolacrimal duct junction bilaterally. Notably, none of the obstructed sides showed intraluminal air.

Conclusion

CTDCI using iopromide is readily accessible, as it employs a contrast agent commonly used in computed tomography and angiography. This technique is non-invasive and does not require specific training, unlike conventional contrast dacryocystography. Although further protocol refinement and a larger patient sample are needed, CTDCI shows potential for assessing the gross anatomy of obstructed lacrimal pathways and may serve as a complementary tool in the diagnostic evaluation of suspected distal lacrimal obstructions.

Additional Authors

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