Korean J Ophthalmol.  2016 Aug;30(4):243-250. 10.3341/kjo.2016.30.4.243.

Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis

• Choi SC
• Lee S
• Choi HS
• Jang JW
• Kim SJ
• Lee JH

• KMID: 2373983
• DOI: http://doi.org/10.3341/kjo.2016.30.4.243

Abstract

PURPOSE
To identify and analyze the role of preoperative computed tomography (CT) in patients with tearing symptoms with nasolacrimal duct obstruction (NLDO).
METHODS
We retrospectively reviewed the medical records and CT results on 218 patients who complained of tearing symptoms with NLDO between January 2014 and December 2014. All patients were recruited from Kim's Eye Hospital's outpatient clinic and assessed by clinical history, examination, and CT to evaluate periocular pathology and nasolacrimal drainage system. Patients with abnormal findings assessed by preoperative CT were further reviewed.
RESULTS
CT was performed on 218 patients (average age, 58.2 ± 11.9 years). Of these, 196 (89.9%) had endonasal dacryocystorhinostomy, 14 (6.4%) declined surgery, and 8 (3.7%) were inoperable due to abnormal CT findings. Soft tissue opacity was the most common finding which 243 cases (85.9%) of 283 obstructed nasolacrimal duct and 89 cases (81.7%) of 109 non-obstructed nasolacrimal duct showed it. Thirty-nine (17.8%) of 218 patients showed either maxillary sinusitis or ethmoidal sinusitis and 32 (14.7%) of 218 patients presented with periocular inflammation. Other abnormal CT findings included septal deviations, previous fractures, masses, and structural abnormalities of nasal cavity.
CONCLUSIONS
Preoperative CT imaging is useful in the assessment of both nasolacrimal drainage and nearby anatomical structures. This information will be helpful in planning surgical interventions and management of NLDO.

Keyword

Endonasal dacryocystorhinostomy; Nasolacrimal duct obstruction; Preoperative computed tomography

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Dacryocystorhinostomy/methods
Female
Follow-Up Studies
Humans
Lacrimal Duct Obstruction/*diagnosis
Male
Middle Aged
Nasolacrimal Duct/*diagnostic imaging/surgery
Preoperative Care/*methods
Retrospective Studies
Tomography, X-Ray Computed/*methods
Young Adult

Figure

• 

  Fig. 1 (A) Computed tomography (CT) of a patient with a normal nasolacrimal duct. In the axial plane CT image, air fills the nasolacrimal duct, which is the passage for tears (arrows). (B) The CT image in the coronal plane also shows empty nasolacrimal ducts (arrows). (C,D) Axial plane and coronal plane of the CT images show the nasolacrimal duct obstructed by soft tissue on both sides (arrows).

• 

  Fig. 2 A 70-year-old female patient with epiphora in both eyes. She had a previous history of nasal trauma. When examining her nose, we found it was totally obstructed by nasal mucosa, and we could not examine the inner structure of nose. The coronal plane of the computed tomography image shows nasal mucosal adhesions in her right nose (arrow).

• 

  Fig. 3 (A) A 61-year-old male patient with epiphora in his right eye, and swelling and pain in his right medial canthal area for 2 months. The axial plane computed tomography image shows that the right maxillary sinus and the ethmoid are filled with soft tissue, with a bulging contour (arrow). (B) The computed tomography image in the coronal plane shows irregular filling of the right maxillary sinus and the ethmoid with irregular bony disruption (arrow).

• 

  Fig. 4 (A) A 58-year-old male patient with epiphora in both eyes, and swelling, anosmia, and pain in his right eye. The axial plane computed tomography image shows irregular marginated evidence of the soft tissue mass ethmoids (arrow). (B) The coronal plane computed tomography image shows a soft tissue mass extending to the medial wall, the sphenoid sinus, and the intracranial area (arrow).

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  Fig. 5 A 47-year-old male patient with epiphora, swelling, and pain in right eye. The computed tomography image in the coronal plane shows severe right ethmoditis and maxillary sinusitis (arrow).

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