A Radiographic Examination of the Nasolacrimal Duct following administration of Iodine Based Contrast Media to define the anatomy of Lacrimal Gland and Nasolacrimal Ducts in search of stenosis and Obstruction

1. DACROCYSTOGRAPHY
PREPARED BY – THAKER ATRI ANUPAM KUMAR
22MSMIT002
MSC. MEDICAL IMAGING TECHNOLOGY
1ST YEAR

2. INTRODUCTION
• A Radiographic examination of the
Nasolacrimal duct(s) following
administration of a contrast medium to
define the Lacrimal gland & NLD system
anatomically in search of stenosis or
obstruction.

3. ANATOMY
• The lacrimal apparatus is the system responsible for the drainage of
lacrimal fluid from the orbit.
• After secretion, lacrimal fluid circulates across the eye, and
accumulates in the lacrimal lake – located in the medial canthus of the
eye. From here, it drains into the lacrimal sac via a series of canals.
• The lacrimal sac is the dilated end of the nasolacrimal duct, and is
located in a groove formed by the lacrimal bone and frontal process of
the maxilla. Lacrimal fluid drains down the nasolacrimal duct and empties
into the inferior meatus of the nasal cavity.

7. INDICATIONS
• Epiphoria
• Obstruction-Canalicular, Nasolacrimal duct
• Chronic dacrocystitis
• Fistula
• Tumors
• Diverticula
• Dacrolith
• Before any intervention to nasolacrimal tract

8. MATERIALS
• Lacrimal canula or 18G blunt needle with polythene catheter. [outside diameter 0.63
mm]
• Contrast - Lipiodol (Better opacification but more chances of granuloma formation) -
Ionic/Non-ionic contrast media.
• 2cc syringe
• Local anaesthetic drops-Lignocaine 4%
• Punctum dilator (Nettleship dilator)
• Cotton tipped applicator

9. TECHNIQUE
• Preliminary anteroposterior, lateral and oblique views are obtained to exclude
radio-opacities that might interfere with interpretation.
• Local anesthetic drops are instilled. Lower end of lid is everted to locate lower
canaliculus at the medial end of lid.
• Inferior punctum is dilated and inferior canaliculus canulated with lacrimal
canula.
• Upper punctum is occluded with cotton tipped applicator.
• 2-3ml of contrast is gently injected to opacify the entire nasolacrimal apparatus.
• It is essential not to advance the catheter more than 3-4 mm into the
canaliculus.

10. FILMS
• Anteroposterior
• Lateral
• Oblique views Films are taken during contrast injection (distension dacrocystography). 5
to 30 minute late films are obtained to evaluate the dye retention.
• Normal dacrocystogram shows complete filling of superior and inferior punctal ampullae,
ascending and descending canaliculi, common duct, lacrimal sac and nasolacrimal duct.
• During procedure patient experiences mild local irritation, pain and bad taste in the
mouth.
• Bilateral injections are· advised as the abnormalities are usually bilateral.

15. COMPLICATIONS
• Contrast extravasation
• Granuloma formation (with lipiodol)
• Injury to canaliculus (perforation)
• Infection

16. REFERENCES
• Radiological Procedures By – Dr. Bhushan N Lakhkar & Dr. Bhushita Lakhkar Guru
• A Guide to Radiological Procedures By – Chapman & Nakielny