Imaging for the Assessment of Lacrimal Drainage System
Author: MEHDI FENDRI
Base Hospital / Institution: Taoufik Hospital Group ( THG )
ePoster presentation
Abstract ID: 24-397
Purpose
A common assessment of primary acquired lacrimal drainage system (LDS) obstruction using clinical examination, dye testing, probing, and irrigation may be insufficient. This study aims to emphasize the importance of imaging the LDS using anterior segment optical coherence tomography (AS OCT) and dacryocystography with computed tomography (CT DCG) for a more precise evaluation.
Methods
CT DCG was performed using multidetector computed tomography with a 50% diluted nonionic contrast agent. Images were acquired initially after diluted contrast instillation at one-minute intervals for five minutes, and subsequently after LDS injection through the inferior canaliculus. AS OCT was performed with a spectral domain OCT to measure the outer diameter (OD) of the punctum.
Results
Forty-five patients with epiphora related to primary acquired LDS obstruction were evaluated using bilateral CT DCG. Additionally, 23 of these patients were also evaluated using AS OCT, and 11 patients underwent only AS OCT. For CT DCG, 21 cases (46.6%) showed complete nasolacrimal duct (NLD) obstruction, while 24 cases (48.8%) showed incomplete obstruction. Complete NLD obstruction was observed at the high level in 38.09% of cases, at the middle level in 23.8%, and at the low level in 33.3% of cases. Incomplete obstructions were extensive along the NLD in 72% of cases, single localized stenosis in 13.5%, and multi-localized in 14.5% of cases. AS OCT revealed mild punctal stenosis (OD between 400 and 500 microns) in 11.7% of cases, moderate stenosis (OD between 200 and 400 microns) in 55.8%, and severe stenosis (OD less than 200 microns) in 32.3% of cases. Punctal stenosis was associated with NLD stenosis in 69.5% of cases.
Conclusion
Acquired LDS obstruction is a heterogeneous condition. Common assessment methods may be insufficient. Imaging of the LDS using both CT DCG and AS OCT provides a more precise evaluation. This improved assessment can impact therapeutic decision-making.
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