|Year : 1965 | Volume
| Issue : 2 | Page : 55-58
X-ray study of the nasolacrimal canal inlet
B Shukla, AH Firdosi
Dept. of Ophthalmology, G. R. Medical College, Gwalior, India
|Date of Web Publication||21-Feb-2008|
Dept. of Ophthalmology, G. R. Medical College, Gwalior
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shukla B, Firdosi A H. X-ray study of the nasolacrimal canal inlet. Indian J Ophthalmol 1965;13:55-8
Dacryocystitis was first believed to be a disease of the orbital bones.-- Duke-Elder (1952). Ferandez (1921) thought that narrowness of the nasolacrimal canal is responsible for the higher incidence of dacryocystitis in the white races as compared to the negroes. Similarly Metier (1929) maintained that higher incidence of the disease in the females is due to narrower nasolacrimal canal. Zabel (1900) and Onodi (1913) observed that a spur on the anterior or the posterior lacrimal crest or a well developed hamular process may constrict the lacrimal sac.
Radiography of the naso-lacrimal canal was first studied by Brunetti (1930) Kopylow (1930) and Toth (1932). Phillips and George (1956) studied the size of the inlet in 10 normal and 17 epiphoric eyes and found no significant difference. Kesavachar (1952) conducted a similar study on 21 normal and 24 epiphoric eyes. He concluded that the epiphoric eyes have a narrower inlet of the naso-lacrimal canal leading to obstruction.
| Material and Method|| |
A random survey of cases of chronic dacryocystitis was done. Fifty cases were selected in all between the ages of 4 and 80 years. Of these 21 were males and 29 were females. Ten normal cases were studied as control. The technique employed was the same as described by Toth (1932) and followed by Phillips and George (1956).
The patient was seated comfortably in a chair and his head was slightly lilted backwards so that the base line between the outer canthus and the external auditory meatus was at an angle of 30° with the horizontal level. In this way the frontal bone does not obstruct the view of the canal. A dental film of 1½ x 2 inches was placed in- side the mouth just beneath the upper second premolar tooth. A small conical X-ray machine was placed above the patient pointing towards the inlet of the naso-lacrimal canal. A current of 10 M.A. was set and an exposure of 3 seconds was given. Similar procedure was repeated for the other side. The film was immediately developed, washed and seen and if the results were unsatisfactory it was repeated.
| Observations|| |
An elliptical contour corresponding to the inlet of the nasolacrimal canal inlet can be seen in the exposed film. The area was measured in square milli- meters from the length and breadth of the opening with the help of a trans- parent graph paper, counting the number of squares covered. The observations were recorded in tabular form of normal, unilateral and bilateral cases. See [Table - 1],[Table - 2],[Table - 3],[Table - 4].
The results cannot be comparable between cases, but since the study comprises mostly a comparison between the right and left inlets of the same patient, the comparisons are significant.
| Discussion|| |
The area of the naso-lacrimal canal inlet, its length, width and course may all contribute to the obstruction of the lacrimal passages. It can be seen [Table - 1] that the area of the nasolacrimal canal inlet is slightly smaller in the females (4.4 mm.). However in view of the fact that there is an average variation between the right and the left inlets in normal cases of 5.6 mm. this difference is of no statistical significance. Again there is little evidence to suggest that the area of the inlet by itself has a significant role [Table - 4].
There is hardly any difference in the average area of the inlet in the normal (23.6 sq mm.) and bilateral cases of chronic dacryocystitis (22.7 sq. mm.). Similarly in the unilateral cases the average difference between the normal and the affected eye was only 3.8 sq. mm., whereas in the normal cases it is 5.6 sq. mm. [Table - 4]. These figures indicate that the area of the inlet of the nasolacrimal canal is not a contributory factor in the pathogenesis of chronic dacryocystitis.
This is in accordance with the observations of Phillips and George (1956), although the observations of Kesavachar are different. However both of them had studied cases of epiphora which were not necessarily cases of chronic dacryocystitis as in the present study.
| Conclusion|| |
The inlet of the nasolacrimal canal was studied by X-rays in ten normal cases and fifty of chronic dacryocystitis. The area of the inlet was measured and compared in sq. mm. and it was concluded that it has no significant bearing in the causation of the disease. However the shape of the canal seems to be an important factor, as a bony spur or septa may very likely cause stenosis as was seen in one case at least.
We are grateful to Dr. K. C. Majupuria and Dr. J. S. Saxena of the Radiology department for their kind help in conducting this study.
| References|| |
Brunetti (1930) Atti Cong. Hal. Radiol. Med., 2, 25.
Duke-Elder (1952) Text Book of Oph.. Vol. 5, p. 5,300. Henry Kimpton. London.
Fernandez (1921) Am. J. Ophth. 4, 32.
Kesavachar K. R. (1958) J. All. Ind. Oph. Soc., 6, 61.
Kopylow (1930) Roentgenpraxis, 2, 686.
Meller (1929) Trans. Ophth. Soc. U.K., 49, 233.
Onodi (1913) Cited by Duke-Elder in Vol. 11. p. 5,303.
Phillips C. and George M. (1956) Brit. J. Oph., 40, 673.
Toth (1932) Klin. Monats. Aug., 89, 555.
Zabel (1900) Anat. Hefte, 15, 153.
[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]