Quantitative lacrimal scintigraphy in the assessment of epiphora.
ABSTRACT The transit of Tc-99m pertechnetate through 122 lacrimal drainage systems was quantified. Systems were categorized as having presac, preduct, intraduct, or no delay. Scintigraphy indicated an obstruction in 81.3% of eyes with epiphora. Of the 18 eyes in whom only scintigraphy revealed an obstruction, all 3 who underwent surgery experienced symptom relief. In patients presenting with unilateral epiphora the mean canthus half-time (12.9 vs. 7.2 minutes), time-to-peak activity at the sac (11.6 vs. 3.1 minute), and sac half-time (19.0 vs. 10.3 minutes) were significantly prolonged in the symptomatic eye. Similarly, the sac-to-canthus (0.32 vs. 0.72), duct-to-canthus (0.32 vs. 0.99), and duct-to-sac ratios (0.48 vs. 0.79) of peak activity were all significantly reduced in the symptomatic eye. When compared with "no delay," "presac," "preduct," and "intraduct" delay were significantly associated with attenuated clearance times or reduced ratios of peak activity corresponding to the level of obstruction. We conclude that there is a significant association between symptomatic epiphora and quantitative variables at the canthus and sac in lacrimal scintigraphy. Quantitative variables help locate the level of an obstruction.
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ABSTRACT: To determine the correlation between lacrimal scintigraphy and a modified Jones primary dye drainage test combined with the fluorescein dye disappearance test (DDT) and Jones secondary dye test, in diagnosing the cause of epiphora. A prospective, consecutive clinical trial was conducted. All patients presenting with epiphora were considered, but those with trichiasis, corneal irritation, lower eyelid ectropion, Bell palsy, or previous lacrimal surgery were excluded. A cohort of 39 patients (65 eyes) underwent the fluorescein DDT and the senior author's (R.B.) modified Jones primary dye drainage test (Jones dye test 1 [JDT1]). For this test, an entire fluorescein 2% Minim dose was instilled in the 2 eyes, and the patient was then asked to gently blow each nostril separately in a white tissue; the degree of fluorescein staining was noted. If there was no fluorescein staining of the tissue (negative JDT1), a traditional Jones secondary dye test (Jones dye test 2) was also performed. All patients except for those testing strongly positive on modified testing or with negative DDT and JDT1 and nil drainage from the nose in Jones dye test 2, indicating anatomical obstruction, were referred for lacrimal scintigraphy. In total, 59 of 65 eyes (91%) showed a positive correlation between the diagnosis arrived at after dye testing using the modified primary dye test and diagnosis on lacrimal scintigraphy. The interrater reliability for the raters was found to be κ = 0.770 and 95% confidence interval = 0.594-0.945. The strength of agreement is considered to be "good." The authors found that in the presence of patent lacrimal drainage system dysfunction, modified Jones primary dye test, combined with the fluorescein DDT and Jones secondary dye test, correlated strongly with lacrimal scintigraphy.Ophthalmic plastic and reconstructive surgery 01/2010; 27(2):81-6. DOI:10.1097/IOP.0b013e3181c8ab70 · 0.91 Impact Factor
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ABSTRACT: Lacrimal scintigraphy (LS) or dacryoscintigraphy can demonstrate abnormalities in 80%-95% of patients with symptoms of epiphora and a patent lacrimal system on syringing and up to 40% asymptomatic individuals. Precise localization of the site of delay may not always be possible due to lack of anatomic detail on LS. LS is considered useful in patients with epiphora with delayed tear clearance and patency to syringing and suspected to have either nasolacrimal duct (NLD) stenosis or lacrimal pump failure. It remains unclear, however, as to whether LS can reliably distinguish between the two. The literature reports considerable variation in the technique, normative data, analysis, and interpretation of LS. Qualitative or visual analysis is simpler to perform and to our knowledge used more frequently in comparison to quantitative analysis. There is little extra information to be gained from LS in cases with complete NLD obstruction or severe NLD stenosis on syringing.Orbit (Amsterdam, Netherlands) 04/2012; 31(2):77-85. DOI:10.3109/01676830.2011.648797
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ABSTRACT: To evaluate the lacrimal gland function in patients with primary Sjögren's syndrome (SS) using lacrimal scintigraphy (LS) and to determine the relationship between clinicopathological stage of primary SS and LS findings. Seventy eyes from 35 patients with primary SS and 20 eyes from 10 healthy age-matched and sex-matched individuals who served as the control group were included in this study. The patients with primary SS were divided into two groups - early stage and advanced stage - according to the labial biopsy scores (23 patients in early stage and 12 in advanced stage). LS, the Schirmer-1 test, determination of break-up time (BUT), Rose bengal ocular surface vital staining and assessment of functional parameters including ocular surface disease index (OSDI) scores were performed for all cases. LS was used to evaluate tear clearance. Lacrimal scintigrams were evaluated for the presence and severity of delayed tear clearance. Delay in clearance was also subclassified according to the severity of delay (mild, moderate, severe and very severe). LS findings and ophthalmological test results of patients in early stage of disease were compared with the results of those in advanced stage and with those of normal individuals. The Schirmer-1 test and BUT values of patients in advanced stage of primary SS decreased significantly, whereas the Rose bengal and OSDI values increased significantly when compared with the values of patients in early stage of primary SS and with those of normal individuals (P<0.05 and P<0.001, respectively). Tear clearance of patients in advanced-stage disease was delayed significantly, compared with the tear delay in patients in early stage of disease and that of normal individuals (P<0.001). An inverse correlation existed between tear clearance and both the Schirmer-1 test and BUT value in all patients (P<0.001). However, there was a positive correlation between both the Rose bengal ocular surface staining values and OSDI scores and tear clearance in all cases (P<0.001). LS findings and ophthalmologic test results were significantly different between early-stage and advanced-stage primary SS. The results indicate that LS, which is correlated closely with ophthalmological test results, may be a useful method for the assessment of the lacrimal gland function in patients with primary SS. LS findings and ophthalmological tests may be used for determining disease severity in primary SS.Nuclear Medicine Communications 04/2012; 33(7):689-94. DOI:10.1097/MNM.0b013e328353bbf2 · 1.37 Impact Factor