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CONTRAST RADIOGRAPHY & SPECIALIZED IMAGING TECHNIQUE: DACRYOCYSTOGRAPHY (DCG)

MS ASMAWATI ISMAIL UNIKL - RCMP

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LEARNING OUTCOMES The end of the topic, students should be able to: 1. Understand the definition and indications of Dacryocystography examination. 2. Describe the patient’s preparation; Radiographer‘s responsibilities; patient care before, during and after the Dacryocystography examination. 3. Explain the technique of Dacryocystography examination.

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DEFINITION ď Ź

Radiographic visualization of anatomic details of the lacrimal drainage system and associated structures after injection of a contrast medium.

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DEFINITION - contd ď Ź

Contrast is injected into the tear canal and then spot film are taken to determine if the duct is blocked or if there is free flow of tears from the eye into the nose.

ď Ź

Visual localization of the site of obstruction may help determine the surgical plan.

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ANATOMY

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ANATOMY - contd

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ANATOMY - contd Tears are produced by the lacrimal gland which lies within the orbit in the upper outer portion of each eye.  The gland continually secretes tears which moisten, lubricate and protect the surface of the eye.  Excess tears drain into small ducts which empty into the nasal cavity. 

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ANATOMY - TEARS 

Tears drain into the tear ducts and down into the nasolacrimal duct.

Tears will accumulate and overflow onto the cheek if there is an excessive amount of tears produced such as in emotional crying or if the duct is blocked.

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INDICATIONS 

Epiphora – watering of the eye in which tears flow onto the cheek. It is due to some abnormality of the tear drainage system. - DCG demonstrate the site and degree of obstruction.

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INDICATIONS - contd Dacryostenosis  A partial or complete blockage in the tear duct system. Causes  The duct system carries tears away from the surface of the eye into the nose by a convoluted tube called the nasolacrimal duct. If this duct is blocked, the tears will accumulate and overflow onto the cheek, even when a person isn't crying. 

In children, the duct may not be completely developed at birth. In adults, it may be due to infection, injury or tumor.

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INDICATIONS – contd 

Nasolacrimal obstruction

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EQUIPMENT ď Ź

Fluoroscopy unit

ď Ź

Silver dilator and cannula / 18G blunt needle with polythene catheter (the catheter technique has the advantage that the examination can be performed on both sides simultaneously).

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PRELIMINARY FILMS 

OM

Lateral CR: inferior orbital margin R

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TECHNIQUE 

The lacrimal sac is slowly massaged to express its contents prior to injection of the contrast.

The lower eyelid is everted to locate the lower canaliculus at the medial end of the lower eyelid.

The lower canaliculus is dilated and the cannula / catheter is inserted. 15


TECHNIQUE - contd 

The lower eyelid should be drawn laterally during insertion to straighten the bend in the canaliculus and to avoid perforation by the cannula.

The spot film are taken immediately during injection (the preliminary views are repeated).

The fluid may cause some trickling in the back of the mouth and there may be a bitter taste in the mouth. 16


TECHNIQUE - contd

ď Ź

Image quality can be increased by enlargement techniques and subtraction, to allow the entire system to be visualized.

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TECHNIQUE - contd AFTERCARE  None (the test does not affect eye sight). COMPLICATIONS  Perforation of the canaliculus.

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RADIOGRAPHS

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RADIOGRAPHS - contd

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RADIOGRAPH - contd

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RADIOGRAPH - contd ď Ź

A patent nasolacrimal system on the right side of a patient and a blocked system on the Lt side at the level of the nasolacrimal duct.

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RADIOGRAPHS - contd

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Dcg