Year : 1984 | Volume
: 32 | Issue : 5 | Page : 364--367
Distension dacryocystography and its results in normal and epiphora cases
AS Mehrotra1, KK Sabharwal2,
1 Department of Ophthalmology, Dr. S.N. Medical College Jodhpur, India
2 Department of Radiology, Dr. S.N. Medical College Jodhpur, India
A S Mehrotra
Department of Ophthalmology and. Radiology, Dr. S.N. Medical College, Jodhpur
|How to cite this article:|
Mehrotra A S, Sabharwal K K. Distension dacryocystography and its results in normal and epiphora cases.Indian J Ophthalmol 1984;32:364-367
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Mehrotra A S, Sabharwal K K. Distension dacryocystography and its results in normal and epiphora cases. Indian J Ophthalmol [serial online] 1984 [cited 2021 Sep 19 ];32:364-367
Available from: https://www.ijo.in/text.asp?1984/32/5/364/27512
Localisation of obstruction in lacrimal .passage has been one of the most difficult problem. The patency of the lacrimal passage may be interrupted due to various factors. Presurgical dacryocystography (D.C.G.) is of great value not only to demonstrate-the block, but also to show whether or not sac is atonic, shrunken or stenosed. Modified distension D.C.G. has great advantage in which contrast media is injected and radiographs are taken while the system is continuously distended by keeping the canula still in the canaliculus thereby giving a good exposure and outline of passage.
MATERIAL AND METHOD
Parent study is based on 20 normal and 76 cases of epiphora attending the eye O.P.D. After taking the necessary history and doing the local examination, the local anaesthesia of the conjunctival sac was done with 2% xylocaine drops in usual manner.
The punctae were dilated and 2ml. syringe with 24 gauge cannula was taken containing 2m1. of diagional viscous solution. With patient in sitting position, the contrast was slowly pushed in sac (it came in the nose with in few seconds in normal cases without any blockage of the passage)and during this injection procedure Water's and lateral projections were taken on X-ray films. The same procedure was done for epiphora cases.
20 cases (12 males and 8 females) were included in the series of normal cases. The average-emptying time of sac was found to be less than 15 minutes (range 12-15 minutes). [Table 1]
Out of a total of 76 cases of epiphora studied, females dominated the number of sufferers, the ratio of female: male was 47: 29 (62 percent females) and age group ranged from 11 to 51 years. [Table 2].
House-Wives are more prone for this problem (60 percent) as seen in [Table 3]. Most of the females come from middle and lower income group working in kitchen and cooking with wood or dried cow-dung, "upla" as a fuel, which gives lot of smoke. Kajal may be another cause of epiphora for majority of these patients.
Left eye is more commonly affected [Table 4] than right eye (51 and 40 percent) and commonest site of obstruction was found to be sac duct junction as seen in [Table 5] (48 percent). This is probably due to constriction at this junction. Second common site was found to be sinus of Mier. There were some nonobstructive cases too [Table 2].
In all these cases the X-rays were taken in sitting posture which obviate patients dis .sub comfort and waste in time in changing position taken supine to prone. The Skiagrams were made during injection of contrast media (Distension dacryosystography). Diagional viscous was used as contrast-media in present study due to the reasons that it is easy to inject gives good radiographic-density, no globule formation, and does not empty too rapidly hence enough time for good radiography, Since it is water soluble it easily mixed with tears, hence more physiological to use.
The level of incomplete obstruction can be confirmed by further radiograph after about 15 minutes of injection when contrast is often still retained above obstruction. This is of great importance in doubtful cases.
In our study of normal cases the average length of sac was noted to be 11.0mm. (range 10-15mm.) which was reported 10.9mm. by Saha et al., 11.0mm. by Mukhopadhya et al and 11.8mm. by Bansal et al  Similarly the length & breadth of nasolacrimal duct was found to be 17.3X4.3mm. in present study whereas it was noted to be 17.5X4.4mm. by choudhary et al, 20.7X2.2mm. by Saha et all and 20.7 X2.6mm. by Bansal et al. In cases of studies the length is reported to be more and breadth less, as compared to ours, probably due to morphological variation.
Common age group in 76 cases of epiphora was 21-30 (30%) that shows young adults are more prone. In 31 to 40 years age group incidence is 17% only. Saha et a1 and Bansal
et a14 found the incidence more common in 31-40 years of age group.
Females are more prone to this problem as seen in present study (62%) as well as by other 57.8% (Mukhopadhya et al), 73% 4 It was still higher (94.05%) in another study.5 Various explanations are given for this by various authors e.g. use of Kajal, relative narrow lacrimal duct etc.
One explanation, on the basis of findings that it is more common in housewives using wood or dried cow dung for cooking, is that the smoke particles are one of the important factors for blockage of duct. This is further supported by the finding that even in males it is more common in labourers doing such work, where they are exposed to dust viz in mines, house construction etc.
Why left side is more common (51%) than right, still requires an explanation. Possible cause may be that labourer or ladies while working in kitchen cleans the sweat more commonly by right arm and more so on right half of the forehead. Thus sweat with dirt get more chance to settle on left side of face & therefore left eye also. These dust & smoke particles can enter left eye more frequently thereby exposing it more for block. This is just one possibility which requires more close observations for confirmation.
Commonest site of obstruction was sacduct junction (48 percent cases), next in order was sinus of Meir & the lacrimal duct (18 & 16 percent respectively). Saha et al reported the incidence still higher i.e. 65.5 percent at sacduct junction whereas Bansal reported a incidence of 40% at this level. High incidence of obstruction at this level is probably due to constriction at this junction. The non obstructive group included, seven cases of epiphora. One of these cases had hypotonic sac, four lacrimal fistulae and one each of obstruction due to maxillary and nasal growths.
Distension dacryocy stography in normal and epiphora cases were done using diagional viscous as contrast media. The plus points of this technique as well as dye are discussed. Epiphora was found more commonly in age group of 21 to 30 years, more so in females (specially in housewives) and left eyes was more commonly affected. Sac-duct junction was common site of obstruction. Possible explanations are discussed.
|1||Saha M.M., Bhardwaj O.P., Malik S.RK, and Jain S.K, 1967. Ind. J. Radiol., 21: 4|
|2||Bansal R.K, Jain A.L., and Om Prakash, 1970. Ind. J. Radiol. 23: 163|
|3||Saha M.M., Bhardwaj O.P., Malik S.RK and Jain S.K, 1967. Ind. J. Radiol. 21: 13|
|4||Bansal R.K, Jain AL., and Om Prakash, 1970. Ind. J. Radiol., 24:168|
|5||Nahata M.C., 1964. Amer. J. Ophthalmol. 58: 580|