Radiological Assessment of Epiphora by Dacryocystography

Objectives- To find out various causes of epiphora, level and type of block in lacrimal passage, lacrimal pump function, causes of failed dacryocystorhinostomy. Materials and Methods- Dacryocystographywas done in 100 eyes of 83 patients of epiphora and divided in three groups , Epiphora with patent lacrimal system, non patent lacrimal system, and residual epiphora after the operation of dacryocystorhinostomy. Dacryocystography was performed by using 0.5-1 ml of urograffin 76% with the lacrimal cannula and X-ray during forceful injection of the dye. A-P lateral & PNS waters view (magnified) were taken by 500 na X-ray Machine. Results- Incidence of epiphora was 41% Right eye, 39% Left eye, 20% both eyes. Male female ratio, 16:84. All age groups are affected almost equally with slight higher incidence in 6 th decade in female.On the basis ofdacryocystography,Complete block in 60% cases, partial block in 9% cases,and no block was observed in 31% cases. Level of block was at Canalicular in 3%, at common canalicular in 7%, at lacrimal sac-duct junction in 84% and at lower end of nasolacrimal duct in 6% of cases. Prevalence of associated ENT disorders about in 24% and atonic sac in 4 cases. Conclusions- Dacryocystography isa simple, easy, cheap, safe and less time consuming investigation, which can be done even at most peripheral level of health services where X-ray facilities are available.


Introduction
Epiphora or excessive drainage ofwater from the eye is almost a universal symptom of disease of lacrimal passage resulting due to improper drainage of tears. It is a very common condition in our rural setup due to unhygienic living conditions illiteracy, poverty, and ignorance and poor infrastructure of health services.
Epiphora due to the lacrimal puncta are misplaced or absent, the lacrimal passage is blocked by atresia, trauma, foreign body or neoplasm. The nose may be obstructed by nasal polyp extreme deviation of nasal septum or inferior turbinate hypertrophy. The Lacrimal pump failure. Adequate assessment of epiphorais necessary for diagnosis & management by syringing & probing of lacrimal passage and dacryocystography

Aims and Objectives
This prospective study has been done with the idea of evaluating & establishing the usefulness of dacryocystography in patients with epiphora for an

Material & Method
The present study was conducted in Department of Ophthalmology in found collaboration of Department of Radiodiagnosis, SRG Hospital & Medical College Jhalawar During 2016 to 2017. 100 eyes of 83 patients complaining of epiphora were selected for dacryocystography and divided in the following groups 1-Epiphora with patent lacrimal system 2-Epiphora with non patent lacrimal system 3-Case of residual epiphora after the operation of dacryocystorhinostomy. Patients with acute or sub acute inflammation were excluded. The 24 G cannual is introduced in punctum. A 30 cm long catheter attached with a 10 cc syringe, is connected to the lacrimal cannula with 0.5-1 ml of urograffin 76% is injected. X-ray exposures are mad during forceful injection of the dye. A-P lateral & PNS Then by the active lacrimal pump mechanism constituted by fiberes of the preseptal portion of the orbicularis. The lacrimal pump pushes the fluid into the nasolacrimal duct with the blinking movements of the eyelids.
Right eye involvements was observed in 41% Left eye involvement in 39% 20% cases had epiphora in both eyes. Male: Female ration was 16:84.
All age groups are affected almost equally with slight higher incidence in 6 th decade in female where ists 27% & also 3 rd decade in Males where its 23% the difference may be due to the fact that only certain specific infection are more common in males, Whereas females in general may suffer from chronic irritation leading to chronic dacryocystitis such as caused by smoke etc. while cooking or doing other household work 5.Poor socio-economic status was observed in 92% of cases.6 Type of Blocks-In this study complete block in the lacrimal passage was observed in 60% cases. Whereas 9% cases had partial block. No block was observed in 31% cases due to some inflammatory changes in lacrimal passage in majority of such cases.
Level of Block-Canalicular block in 3% cases, common canalicular block in 7% cases, block at lacrimal sac-duct junction in 84% and lower end of nasolacrimal duct in 6% of cases. 5 We have done dacryocystography in 13 cases of residual epiphora, out of which we found block in 10 cases Out of these cases we observed sommon canalicular block in 20% cases block of bony passage in 20% cases & intact sac was present in 60 & cases.
This clearly shows that most common cause of residual epiphora was due to making and suturing of false flaps of muscular layer or lamellar sac flap i.e. improper sac flaps. Prevalence of associated ENT disorders about in 24% of cases of epiphora.

Summary and Conclusion
We have found dacryocystography to be a simple, easy, cheap, safe and less time consuming investigation which can be done even at most peripheral level of health services where X-ray facilities are available.
It is most informative in relation to localizing exact level of block and associated pathology as compared to other sophisticated investigations which require modern high technology that happen to be very costly and not easily available in most parts of our country dacryocy stographyalos does not lead to any complication or after effects.
Funding: Nil, Conflict of interest: None. Permission of IRB: Yes