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Lacrimal Complex Dysfunction
Paige Bennett, MD; Zachary Allen Lindsey, MD
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KEY FACTS

  • TERMINOLOGY

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Dacryoscintigraphy is used to evaluate etiology of obstruction in patients with epiphora (tear overflow, often as a result of eye irritation or obstruction of lacrimal system)
              • Mechanical obstruction
                • Complete obstruction: Obstruction of lacrimal system resulting in radiotracer pooling at site of obstruction and no passage of radiotracer distal to obstruction
                • Partial obstruction: Stenosis of lacrimal system resulting in radiotracer pooling at site of obstruction and delayed passage of radiotracer distal to obstruction;
              • Functional obstruction
                • Defined as epiphora in setting of lacrimal system that is patent to syringing
                  • Secondary to abnormal lacrimal pump function
            • Dacryoscintigraphy replaces dacryocystography (imaging of lacrimal system using radiopaque dye injected into lacrimal complex)

          IMAGING

          • General Features

            • Nuclear Medicine Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Gross Pathologic & Surgical Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Detorakis ET et al: Lacrimal outflow mechanisms and the role of scintigraphy: current trends. World J Nucl Med. 13(1):16-21, 2014
                                      2. Kemeny-Beke A et al: Simultaneous dacryocystography and dacryoscintigraphy using SPECT/CT in the diagnosis of nasolacrimal duct obstruction. Clin Nucl Med. 37(6):609-10, 2012
                                      3. Palaniswamy SS et al: Dacryoscintigraphy: an effective tool in the evaluation of postoperative epiphora. Nucl Med Commun. 33(3):262-7, 2012
                                      4. Chung YA et al: The clinical value of dacryoscintigraphy in the selection of surgical approach for patients with functional lacrimal duct obstruction. Ann Nucl Med. 19(6):479-83, 2005
                                      5. Goldberg D: Nasolacrimal duct obstruction. Ophthalmology. 112(6):1173-4; author reply 1174, 2005
                                      6. Marr JE et al: Management of childhood epiphora. Br J Ophthalmol. 89(9):1123-6, 2005
                                      7. Wormald PJ et al: Investigation and endoscopic treatment for functional and anatomical obstruction of the nasolacrimal duct system. Clin Otolaryngol Allied Sci. 29(4):352-6, 2004
                                      8. Zilelioglu G et al: Quantitative lacrimal scintigraphy after dacryocystorhinostomy. Ophthalmic Surg Lasers Imaging. 35(1):37-40, 2004
                                      9. Soparkar CN et al: Evaluation of the lacrimal sac. Ophthalmology. 110(12):2434-5; author reply 2435-6, 2003
                                      10. Nasolacrimal duct obstruction (dacryostenosis) in children
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • TERMINOLOGY

                                        • Imaging

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Definitions

                                                • Dacryoscintigraphy is used to evaluate etiology of obstruction in patients with epiphora (tear overflow, often as a result of eye irritation or obstruction of lacrimal system)
                                                  • Mechanical obstruction
                                                    • Complete obstruction: Obstruction of lacrimal system resulting in radiotracer pooling at site of obstruction and no passage of radiotracer distal to obstruction
                                                    • Partial obstruction: Stenosis of lacrimal system resulting in radiotracer pooling at site of obstruction and delayed passage of radiotracer distal to obstruction;
                                                  • Functional obstruction
                                                    • Defined as epiphora in setting of lacrimal system that is patent to syringing
                                                      • Secondary to abnormal lacrimal pump function
                                                • Dacryoscintigraphy replaces dacryocystography (imaging of lacrimal system using radiopaque dye injected into lacrimal complex)

                                              IMAGING

                                              • General Features

                                                • Nuclear Medicine Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Gross Pathologic & Surgical Features

                                                          • Microscopic Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Detorakis ET et al: Lacrimal outflow mechanisms and the role of scintigraphy: current trends. World J Nucl Med. 13(1):16-21, 2014
                                                                          2. Kemeny-Beke A et al: Simultaneous dacryocystography and dacryoscintigraphy using SPECT/CT in the diagnosis of nasolacrimal duct obstruction. Clin Nucl Med. 37(6):609-10, 2012
                                                                          3. Palaniswamy SS et al: Dacryoscintigraphy: an effective tool in the evaluation of postoperative epiphora. Nucl Med Commun. 33(3):262-7, 2012
                                                                          4. Chung YA et al: The clinical value of dacryoscintigraphy in the selection of surgical approach for patients with functional lacrimal duct obstruction. Ann Nucl Med. 19(6):479-83, 2005
                                                                          5. Goldberg D: Nasolacrimal duct obstruction. Ophthalmology. 112(6):1173-4; author reply 1174, 2005
                                                                          6. Marr JE et al: Management of childhood epiphora. Br J Ophthalmol. 89(9):1123-6, 2005
                                                                          7. Wormald PJ et al: Investigation and endoscopic treatment for functional and anatomical obstruction of the nasolacrimal duct system. Clin Otolaryngol Allied Sci. 29(4):352-6, 2004
                                                                          8. Zilelioglu G et al: Quantitative lacrimal scintigraphy after dacryocystorhinostomy. Ophthalmic Surg Lasers Imaging. 35(1):37-40, 2004
                                                                          9. Soparkar CN et al: Evaluation of the lacrimal sac. Ophthalmology. 110(12):2434-5; author reply 2435-6, 2003
                                                                          10. Nasolacrimal duct obstruction (dacryostenosis) in children