eye nuclear medicine

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othalmology nuclear medicine

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Lacrimal Ducts scintigraphy(Dacryoscintigraphy) : 

Lacrimal Ducts scintigraphy(Dacryoscintigraphy) Dr.MUSTAFA IBRAHIM

Introduction : 

Introduction EPIPHORA, or pathological overflow of tear, is a common symptom encountered in ophthalmology and is usually due to an obstruction of the lacrimal excretion system. Other causes include xerophthalmia, foreign bodies, and drug induced tear overproduction.

Introduction : 

Introduction Patients who complain of epiphora without tear overproduction, but show easy passage on syringing are said to have functional lacrimal duct obstruction. Functional obstruction is delayed or blocked tear excretion in the absence of mechanical obstruction of the lacrimal excretion system, and its causes can be categorized into stenosis of the lacrimal excretion system, anomalous location or blockage of the punctum, and dysfunction of the lacrimal pump .

LACRIMAL DRAINAGE SCINTIGRAPHY TECHNIQUE : 

LACRIMAL DRAINAGE SCINTIGRAPHY TECHNIQUE A drop of Tc-99m – Tin colloid is placed into the inferior fornix of both eyes( lateral portion of each eyeball ). patient is requested to remain still , but to blink normally. A dynamic study is performed initially, with the tracer distribution imaged every 10 seconds for the first 160 seconds . Static views were then taken routinely at 5, 10, 15, 20 and 30 minutes.

Slide 5: 

Interpalpebral fissure, lacrimal sac and nasolacrimal duct were filled with tracer ,ativity reached the nose

Normal Dacryoscintigraphy : 

Normal Dacryoscintigraphy Radiotracer flowed from the conjunctival sac to the nose The transit time through the distal part of the nasolacrimal duct and into the nasal space is extremely variable in normal individuals.

The scintigraphic appearances were subdivided into three groups : 

The scintigraphic appearances were subdivided into three groups Presac delay", defined as hold up at the inner canthus or failure of the tracer to reach the lacrimal sac by the end of the dynamic study. Preductal delay", with early filling of the lacrimal sac, but no sign of sac emptying on the first static image at 5 minutes. Intraduct delay", evidenced by nuclide in the upper part of the nasolacrimal duct at 5 minutes, but no further drainage over the next 15 minutes

Pre-sac delay : 

Pre-sac delay Bilateral pre-sac obstruction Tracer filled in the interpalpebral fissure and later on collect in the median canthum No visualization of the lacrimal sac or lacrimal ducts

Pre-sac delay : 

Pre-sac delay Unilateral right sided pre-sac obstruction

The value of dacryoscintigraphy in clinical management. : 

The value of dacryoscintigraphy in clinical management. The differentiation of abnormal scintigrams into presac, preductal, or intraductal delay may provide additional information of value in clinical management. Many cases with presac retention may have a primarily canalicular problem Cases suspicious of pre-lacrimal sac obstructions in particular may achieve better operative results with adjuvant treatments in addition to silicone tube insertion.

Pre-ductal and Intra-ductal Delay : 

Pre-ductal and Intra-ductal Delay Dynamic study with rapid entry of tracer into the lacrimal sac on the right and upper nasolacrimal duct on the left

Slide 12: 

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