DCG abnormality categories | Lacrimal syringing finding(s) associated with each DCG abnormality category | Abnormalities misinterpreted when using lacrimal syringing alone |
---|---|---|
Normal | Normal | This syringing category would miss a lacrimal sac diverticulum, a high anastomosis or lacrimal sump syndrome. |
Upper or lower canalicular block | Full reflux through the same punctum as the canula is inserted into | Not applicable. |
Common canalicular block | Full reflux through upper or both puncta, no fluorescein regurgitation | This syringing category would encompass a very small fibrosed sac remnant, which is unable to hold a significant amount of fluorescein but has a greater rate of success following revision DCR. |
Completely closed anastomosis | Full reflux through upper or both puncta, with fluorescein regurgitation | This syringing category would miss a completely closed anastomosis with a partially patent NLD and could encompass an anastomosis into a nasal sinus. |
Narrow surgical anastomosis | Partial reflux of saline, partial passage of saline to the nose | This syringing result could encompass an anastomosis into a nasal sinus, and a completely closed anastomosis with a partially patent NLD. These two abnormalities would be suggested with an absence of fluorescein in the nasal cavity on endoscopy, although it would not discern between the two as the nasal endoscope cannot be passed under the inferior turbinate in clinic. |
Anastomosis draining into a nasal sinus | Partial or complete reflux on lacrimal irrigation with no passage of saline into the nasal cavity | Syringing alone would only show partial or complete reflux on lacrimal irrigation. DCG is required to identify location of blockage into a nasal sinus. |