Non-contrast MR dacryocystography for the evaluation of epiphora and recurrent dacryocystitis: A preliminary study

Comparing the diagnostic accuracy of MR dacryocystography (MRD) and dacryoscintigraphy (DSG) in NLDO-related acquired epiphora

PROPOSE

This study aimed to compare the diagnostic accuracy of MR dacryocystography (MRD) and dacryoscintigraphy (DSG) in the diagnosis of acquired epiphora related to NLDO. A total of 15 patients with acquired epiphora and suspected NLDO were included in this study.

METHODS

All patients underwent MRD and DSG examinations. MRD was performed using a 3-Tesla magnetic resonance imaging (MRI) scanner, while DSG involved injection of a radiotracer into the lacrimal drainage system followed by DSG. The results of both imaging methods were compared with the reference standard that was a combination of clinical examination findings and surgical exploration.

RESULTS

The results of this study showed that no abnormal findings were observed in MR-DCG in patients before the Valsalva maneuver. However, after the Valsalva maneuver, stenosis/obstruction at the canal surface was observed in all 15 patients diagnosed by DSG, giving a sensitivity of 100% for canal stenosis. Moreover, the results revealed that among these 15 patients, 9 showed stenosis or simultaneous obstruction at the level of the canal and lacrimal sac, but MR-DCG showed these lesions in only 9 patients, giving a sensitivity of 60%. The specificity of MRD and DSG were 85% and 76.7%, respectively. There was a statistically significant difference in the sensitivity of MRD and DSG (p < 0.05).

CONCLUSION

This study demonstrated that MRD has a higher diagnostic accuracy in the diagnosis of acquired epiphora associated with NLDO compared to DSG. MRD showed significantly higher sensitivity and specificity than DSG. Therefore, MRD can be considered as the preferred imaging modality in the diagnosis of acquired epiphora due to NLDO. By accurately identifying the underlying cause of NLDO, MRD can help determine the most appropriate treatment approach for patients and lead to better outcomes.

The Endoscopic Endonasal Dacryocystorhinostomy (eDCR) in the Immunocompromised Patient

We present the clinical case of a 51-year-old male patient, affected by common variable immunodeficiency (CVID). In his history recurrent orbital cellulitis, exacerbation of chronic right dacryocystitis, lacrimal sac empyema with periodic episodes of dacryocutaneous fistolization. The coexistence of these particular immunological defects and the lack of literature about similar cases required an accurate evaluation of each step of the diagnostic and therapeutic approach. We performed an endoscopic endonasal dacryocystorhinostomy with "cold" instruments. No surgical complications were observed in the immediate postsurgical period. We balanced the necessity of a follow-up based on frequent office evaluation and the current pandemic emergency, in order to not expose the patient to an additional infectious risk. The discussion will focus on several aspects: the adequacy of radiological, the "cold" surgical technique, the choice of avoiding endocanalicular prostheses. We will discuss also about the use of oral and topical therapy, avoiding probable post-surgical infectious complications.