Comparison of dacryocystography and lacrimal scintigraphy in the investigation of epiphora in patients with patent but nonfunctioning lacrimal systems.

Purpose: To assess and compare dacryocystography and lacrimal scintigraphy in the management of patients with epiphora and patent but nonfunctioning lacrimal systems.

Methods: Data were collected retrospectively over a 3-year period from all patients having both dacryocystography and lacrimal scintigraphy for epiphora where clinical examination indicated delayed tear clearance but the lacrimal system was patent. Both investigations were evaluated for presence, site, and severity of delayed clearance. Dacryocystograms were also evaluated for reflux and anatomical abnormalities. The findings were assessed in a masked fashion and compared with the clinical examination.

Results: More than 200 lacrimal systems in 107 patients were examined. An abnormality was present in one or both investigations in 92% of systems. There was greater agreement between clinical evaluation and scintigraphy than for dacryocystography. Abnormalities were detected with scintigraphy and dacryocystography in 78% and 56% of systems (25% delay, 11% anatomical abnormalities, and 20% both), respectively. Overall agreement was 52%. Disagreement occurred mainly with a normal dacryocystogram and abnormal scintigram. There was agreement for site of blockage in 59%; however, scintigraphy detected a block at a more proximal level in 38%.

Conclusions: In the investigation of epiphora in patients with apparent outflow obstruction but patent lacrimal systems, both dacryocystography and scintigraphy are often abnormal. The authors' study shows that scintigraphy is the more sensitive test, correlating more closely with the clinical examination and often detecting more proximal and severe obstruction, and appears to be the investigation of choice in these patients.