Dacryocystography provides very good anatomical detail of the outflow system -revealing occlusion, stenosis or dilatation of the outflow tract and also, in some cases, diverticulae, stones, or tumour (Figure 10.17) -but does not give a true measure of the physiological function. However, where the system is patent during injection of contrast, the failure of spontaneous clearance of oil-based contrast media after the patient resumes

Figure 10.16 Intranasal tumour causing epiphora.

Figure 10.17 Dacryocystography showing: (a) an anatomically normal left system but a dilated right lacrimal sac with filling defect due to a stone; (b) an anatomically normal right system (although contrast reflux suggests distal stenosis within the outflow tract) and a tiny, non-functional left surgical anastomosis after endonasal dacryocystorhinostomy, (c) a small right and large left mucocoele; (d) a functional right dacryocystorhinostomy with direct drainage of contrast to the nasal space.

the upright posture is suggestive of a reduced physiological clearance (so-called "functional block").

Dacryocystography is indicated in planning endonasal lacrimal surgery, or with surgery for congenital lacrimal anomalies, after trauma, after cranio-facial repair, with revisional lacrimal surgery, or where a tumour or sequestrum within the system is suspected. A dilated canalicular system with filling defects may be evident in Actinomyces canaliculitis (Figure 10.18). There is no indication for dacryocystography where clinical signs indicate an uncomplicated lacrimal sac mucocoele.

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