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

Purpose: To relate dacryoscintillographic features to presenting symptoms and signs for watery-eyed patients with patent drainage systems.

Methods: 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.

Results: 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).

Conclusion: 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.