Dacryoscintillography in Patients With Symptomatic, but Patent, Lacrimal Drainage Systems

The objective was to relate dacryoscintillographic features to presenting symptoms and signs for watery-eyed patients with patent drainage systems.

Retrospective case note and imaging review for patients with watering eye(s) and clinical evidence of impaired tear drainage who underwent dacryoscintillography (DSG). Three DSG features were graded, along with 4 symptoms, 7 signs, and the degree of fluid reflux and nasal fluid passage on gentle syringing. For symptomatic systems, the DSG characteristics were compared with the presenting symptoms and signs, and a side-to-side comparison was made for unilateral cases.

DSGs were reviewed for 65 patients (43% males), presenting at a mean age of 62.8 years, and 57/65 (88%) having bilateral symptoms. The objective increase in tear lake was inversely related to all 3 DSG measures in 122 symptomatic drainage systems, whereas fluorescein disappearance correlated directly with tracer entry into the lacrimal sac ( p < 0.05). Tracer entry into the nasolacrimal duct mirrored nasal fluid passage on lacrimal irrigation ( p = 0.00055) and was inversely related to ocular fluid reflux ( p = 0.0086). In 8 patients with unilateral symptoms, some DSG parameters on the symptomatic side were related to clinical signs; in contrast, on the asymptomatic side, only the nasal entry of tracer was (inversely) related to an objective increase in the tear lake ( p < 0.05).

Abnormal DSG tracer clearance occurs at various levels in watery-eyed patients with patent lacrimal systems, but the findings do not add significantly to the results of a thorough clinical examination. Abnormalities of clearance were also often present in asymptomatic fellow eyes.