• Idiopathic (80%)

• Trauma/midface fractures

• Iatrogenic

1. Irradiation

2. Radioactive iodine treatment (RAI)

3. Extensive maxillary antrostomy

4. Nasal osteotomy in rhinoplasty


• Inverting papilloma

• Lacrimal sac tumor


• Granulomatosis with polyangiitis (GPA)

• Sarcoidosis

• Sicca/Sjögren’s syndromes


• Eyelid laxity/malposition

• Facial palsy/paralysis

• Scarring/mass obstruction

• Entropion

• Ectropion

Diagnostic Evaluation of Epiphora

Ophthalmologic Testing

• Fluorescein dye test

1. Fluorescein solution of 2% instilled in conjunctival cul-de-sac

2. Persistence/asymmetric clearance at 5 minutes indicates decreased outflow

• Jones Test

1. Jones 1: performed following fluorescein dye test

– Dye placed in inferior conjunctival cul-de-sac

– Duration of 5 to 10 minutes: attempt to recover from inferior meatus

2. Jones 2: performed following Jones 1 testing

– Saline irrigation through lacrimal system

– Irrigant in nose indicates low grade obstruction

– Dye in irrigant indicates low sac or duct obstruction and patent canalicular system

3. Lacrimal Probing

– Performed after negative Jones 2 test

– Measure distance at which obstruction encountered


• Computed Tomography (CT)

1. Allows identification of associated sinus disease, septal deviation, anatomic abnormality, or tumor

2. Good for evaluation of bony anatomy

3. Useful for intraoperative image guidance

• Magnetic Resonance Imaging (MRI)

1. Rarely utilized

2. Good for soft tissue anatomy

• Ultrasound

1. Simple, noninvasive evaluation of nasolacrimal system

2. Cannot evaluate canalicular or physiologic obstruction

3. Able to identify dilated sac, neoplasm, or dacryolith

• Dacryoscintigraphy (DS)

1. Radionuclide solution instilled in eye and physiologic flow assessed while images obtained

2. Poor resolution limits usefulness

• Dacryocystography (DCG)

1. Gold standard of nasolacrimal system imaging

2. Radiopaque contrast solution instilled into canaliculus

3. DCG-CT allows for greater bony detail

4. DCG-MRI allows for fine soft tissue detail and can differentiate mucous, blood, and neoplasm

5. Percutaneous-contrasted DCG allows bypass of common canalicular obstruction and evaluation of lacrimal sac

Jul 20, 2019 | Posted by in OTOLARYNGOLOGY | Comments Off on Dacrycystorhinostomy
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