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C. Haller, T.M. Haller; The Use of Lacrimal Scintigraphy for Assessment of Partial and Functional Nasolacrimal Duct Obstruction . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2423.
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Purpose: Functional nasolacrimal duct obstruction is a clinical situation when a patient is symptomatic with epiphoria and has an increased tear line, but the lacrimal drainage system is patent upon syringing. Partial NLD obstruction is similar to functional NLD obstructions in that the drainage is patent using syringing, but there is some resistance demonstrated. While there are a number of radiological studies to assess tear drainage, lacrimal scintigraphy is considered to be the most physiologic of tests. The purpose of this study is to present clinical situations where lacrimal scintigraphy plays a major role in assessment of epiphoria, along with one circumstance where scintigraphy complicated the evaluation. Methods: Adult patients who were clinically diagnosed as having unilateral or asymmetric bilateral, partial or functional nasolacrimal duct obstruction were administered 50–100 uCi of technetium–99m pertechnetate into the inferior fornices of both eyes and tracer distribution images were performed using a Forte 1.41r01 gamma camera at 1, 3, 6, 10, 20, 30, and 45 minutes. Results: The scintigraphy studies were able to demonstrate either delayed flow through lacrimal system or a point of obstruction under physiologic conditions of tear production and drainage. In one instance, scintigraphy was read as a patent lacrimal system by a radiologist but it was determined to be a false negative. Conclusions: Lacrimal scintigraphy is a useful diagnostic tool in situations where traditional clinical testing does not correlate with a patient’s symptoms. The study is non–invasive, poses negligible risk to the patient, and is highly sensitive.
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