Syringing has limited sensitivity and specificity in nasolacrimal duct drainage impairment

Yinon Shapira, Valerie Juniat, Carmelo Macri, Dinesh Selva

Meeting:  2022 RANZCO


Date:      -

Session Title: FREE PAPERS – Oculoplastic/Ocular Oncology

Session Time:      -

Purpose: To elucidate the role of the lacrimal syringing (LS) in the assessment of nasolacrimal duct (NLD) steno- sis and in functional NLD delay.

Methods: Retrospective review of consecutive adult patients with epiphora attending a tertiary lacrimal clinic from August 2007 to January 2021. Following LS, patients were investigated with dacryocystography (DCG) and dacryoscintigraphy (DSG). Cases with evidence of canalicular obstruction/stenosis on syringing and/or DCG or presac delay on DSG were excluded. Patients with other identifiable causes of epiphora were excluded The sensitivity and specificity of LS were evaluated using the combined findings on DCG and DSG.

Results: Both DCG and DSG were available for 235 symptomatic lacrimal systems (156 patients; mean age 65.5±16.1 years, 60.3% females). One-third of cases that had both normal DCG and DSG were noted to have some degree of reflux on LS (specificity = 66.7%). 27.2% of lacrimal systems with both abnormal DCG and DSG were fully patent on LS (sensitivity = 72.8%). The sensi- tivities were considerably lower for NLD stenosis (i.e. stenosis on DCG and delay on DSG) and for func- tional NLD delay (i.e. normal DCG and delay on DSG), of which 43.5% and 57.4% had full patency on syringing,

Conclusions: Based on the combined findings of DCG and DSG, full patency on syringing was not reliable for ruling out NLD stenosis or functional delay. In a patient with epiphora where we have excluded other causes and punctocanalicular pathology, strong consideration should be given to further investigation in the context of nega- tive syringing.