[Study of computed tomographic dacryocystography used in endoscopic intranasal dacryocystorhinostomy preoperatively]

OBJECTIVE

To study computed tomographic dacryocystography used in endoscopic intranasal dacryocystorhinostomy preoperatively.

METHOD

Ten volunteers and twelve patients with dacryocystitis were undergone the coronary and axial computed tomographic dacryocystography.

RESULT

According to the anatomic relationship between anterior ethmoid sinus and fossa of lacrimal sac, the cells of anterior ethmoid sinus were classified into three typies: the result was that type I accounted for 12 sides (27.3%), type II 18 sides (40.9%), type III 14 sides (31.8%) by analysing the data of axial dacryocystographies; the sites of obstruction were connection of the lacrimal sac with nasolacrimal duct, the form of lacrimal sac of 11 patients was normal or enlarged lacrimal sacs, bilateral cricatrized lacrimal sacs were found in one patient by analysing the data of coronary dacryocystographies.

CONCLUSION

Computed tomographic dacryocystography preoperatively can provide significant clinical guidance for the endoscopic transnasal dacryocystorhinostomy in locating the site of bone-opening.

[Eye disease in painters--Camille Pissaro]

Some vision disorders to painters have influenced their work. Camille Pissarro the dean of impressionism, presented from forty-eight years dacryocystitis on his left eye and ipsilateral conjunctive chemosis temporally. In that time the treatment consisted in incision and drainage of the lacrymal sac, and cauterization. Due this chronic disease he was forced to paint inside, behind closed windows, in order to avoid dust and wind. This situation influenced the subjects of his painting. His painting reflects large crowds Paris avenues and buildings. This is characteristic for his wonderful works.

Intranasal laser-assisted dacryocystorhinostomy with the use of a surgical microscope

PURPOSE

Obstruction of the nasolacrimal duct is a serious chronic condition, treatment for which has not yet been successfully resolved. Several methods have been proposed for the management of chronic epiphora. A modified method of intranasal laser-assisted dacryocystorhinostomy with the use of a surgical microscope is described.

MATERIALS AND METHODS

The procedure is a modification to the West and Veis-Claus-Guttich method. The primary and late results of this method are presented for 53 patients over the past 7 years with chronic epiphora caused by stenosis of the nasolacrimal duct. Selection criteria included chronic epiphora, nasolacrimal duct stenosis due to Down syndrome, empyema of the lacrimal sac, and recurrence from previous operations. Patients were operated on under general anesthesia.

RESULTS

Fifty-one patients (96.3%) were free of symptoms postoperatively (mean follow-up time, 6 months).

CONCLUSION

The simplicity of this method compared with traditional methods is correlated with excellent postoperative results and patient satisfaction.

Involvement of the lacrimal drainage system by leukemia or lymphoma

PURPOSE

To determine the clinical characteristics and outcomes of patients with leukemic or lymphomatous involvement of the lacrimal drainage system (LDS).

METHODS

A computerized retrieval system was used to identify patients with histologically proven leukemic or lymphomatous involvement of the LDS. Medical records were reviewed.

RESULTS

Biopsies of the lacrimal sac or nasolacrimal duct obtained during dacryocystorhinostomies (DCR) performed at the Mayo Clinic (Rochester, Minnesota) between January 19, 1989, and August 26, 1997, were positive for leukemia or lymphoma in 11 patients (15 LDS). Ten patients had previously diagnosed leukemia or lymphoma; the interval between the diagnosis of systemic disease and DCR averaged 5.8 years (range, 7 months to 13 years; median, 5 years). The median age at the time of LDS involvement was 72 years (range, 49 to 85 years). Seven patients (64%) were women, and all were white. The median postoperative follow-up after DCR was 38 months (range, 10 to 65 months). Eight patients had leukemic infiltration of the LDS, 2 patients had B-cell lymphoma, and 1 patient had cutaneous T-cell lymphoma. Four patients had bilateral LDS involvement, and the remainder had unilateral disease (right eye, 1 patient; left eye, 6 patients). The most common initial presentation, in 9 patients (82%), was epiphora. Lacrimal irrigation of 2 LDS was deferred because of acute dacryocystitis. Of the remaining 13 systems, 8 were completely obstructed. The blockage was low (in the lower sac or in the nasolacrimal duct) in 6 systems and high (in the upper sac or common internal punctum) in 2 systems. Four LDS were anatomically patent to irrigation but were functionally obstructed. Chemotherapy was the primary treatment in 7 patients, whereas 4 patients underwent radiation therapy. Nine patients responded well to treatment, with alleviation of signs and symptoms, and none of these patients had local recurrence during the follow-up interval.

CONCLUSIONS

Leukemic or lymphomatous involvement of the LDS is an unusual cause of tearing in elderly patients, but it should be suspected in patients with known systemic disease. Treatment comprising multiple interventions improves the signs and symptoms of this complication of lymphoproliferative disorders in most patients.

[Probing of lacrimal passage on congenital dacryocystitis]

PURPOSE

To investigate the effects of probing of lacrimal passage on congenital dacryocystitis.

METHODS

474 consecutive infants with congenital dacryocystitis were treated with probing of lacrimal passage. The data were retrospectively analyzed.

RESULTS

In 474 eyes, there were 360 and 122 eyes with or without membranous block respectively, and 356 (98.89%) and 107 eyes (85.25%) with or without membranous resistance were respectively cured with probing of lacrimal passage; there were 12 eyes with stenosis and 8 eyes (66.67%) were cured. In operation, 1 and 3 eyes were respectively suffered from subcutaneous edema and laceration of canaliculus, but there was no baby suffered from infection or asphyxia.

CONCLUSIONS

The effects of probing of lacrimal passage were related to the causes of obstruction of lacrimal passage, and it is very important to scrupulously feel in probing lacrimal passage.

Endoscopic marsupialization of congenital nasolacrimal duct cyst with dacryocoele

A congenital nasolacrimal duct cyst is an uncommon condition in the newborn usually treated by ophthalmologists. Prolapse or expansion of the cyst into the nose may lead to respiratory distress and difficulty in feeding as newborns are obligate nose breathers, which needs the involvement of the Otolaryngologist in diagnosis and management. The authors report a series of 8 children presenting with a congenital nasolacrimal duct cyst and dacryocoele and highlight the importance of endoscopic nasal examination of newborns presenting with respiratory problems. Diagnostic studies included intranasal endoscopy and CT scanning of the nasolacrimal system and nose. All the patients were treated by endoscopic marsupialization of the cyst. Nasolacrimal duct abnormality should be considered in the differential diagnosis of neonatal respiratory distress and nasal obstruction. Nasal endoscopy is essential in the work-up of all children with nasal obstruction and respiratory distress. CT scanning is the investigative method of choice. Endoscopic marsupialization followed by lacrimal duct irrigation is effective in the treatment of congenital nasolacrimal duct cyst and results in complete resolution of symptoms.

[Pyogenic granuloma of the lacrimal sac]

BACKGROUND

Pyogenic granulomata belong to the group of inflammatory pseudotumours. They consist of granulation tissue usually following inflammatory processes or trauma.

PATIENT

We report on a 86-year old female suffering from chronic dacryocystitis. In the course of the treatment exstirpation of the lacrimal sac was performed. The removed tissue was analysed histologically.

RESULTS

Histological examination revealed a dense lymphoplasmacellular infiltration underlying the epithelium of the lacrimal sac. A mushroom-like tumour rising into the lumen of the lacrimal sac could be observed. This tumour consisted of capillaries and a dense inflammatory infiltrate. The findings were consistent with a pyogenic granuloma of the lacrimal sac.

CONCLUSION

Pyogenic granulomata usually arise in the conjunctiva as a sequel of chronic lipogranulomatous inflammation. They are very rare in other areas such as the lacrimal drainage system.

Dacryocystorhinostomy for dacryocystitis caused by methicillin- resistant Staphylococcus aureus: report of four cases

BACKGROUND

To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA).

CASES

Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics.

OBSERVATION

Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively.

CONCLUSION

Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.

[Treatment for chronic dacryocystitis by dacryocystorhinotomy with Ho: YAG laser under endoscope]

OBJECTIVE

To analyze the experience and curative effect in treating chronic dacrocystitis by dacryocystorhinotomy with Ho:YAG laser under endoscope.

METHOD

20 patients of chronic dacryocystitis were treated by dacryocystorhinotomy with Ho:YAG laser under endoscope, followed-up for 1 approximately 2 years to observe the curative effects.

RESULT

One was unplugged 8 months after the operation, six after 6 months, four after 4 months and nine after 3 months. No recidivations was found one year after the operation and the effective rate was 100%. There was no complications in all of the cases.

CONCLUSION

The technique of dacryocystorhinotomy with Ho: YAG laser under endoscope overcomes the disadvantages of traditional method of operation.

[Chronic dacryocystitis fistulization in a Rubinstein-Taybi syndrome]

The article presents the treatment difficulties of the chronic dacryocystitis at an eight month old patient, diagnosed with Rubinstein-Taybi syndrome. The difficulties occurred as a result of numerous antibiotic treatments and surgical procedures suffered by the patient since his second week of life.

[Indications and prognosis of dacryocystorhinostomy in childhood. A clinical study 1970-2000]

BACKGROUND

Dacryocystitis in infants is a serious complication of congenital, but seldom of acquired nasolacrimal duct obstructions. If conservative treatment fails, dacryocystorhinostomy (DCR) appears to be effective. The indications, special clinical history and results will be reviewed.

PATIENTS AND METHODS

From 1/1970 to 2/2000, a total of 72 children (56 male, 16 female) with persistent dacryocystitis (18 bilateral) were treated surgically by DCR and were continuously documented. The patients ranged in age from 10 months to 14 years old (mean age 4.9 years). Included in our study were 66 children (52 male, 14 female) with 84 surgically treated lacrimal ducts (46 right eyes, 38 left eyes) who underwent control examinations.

RESULTS

The cause of dacryocystitis was congenital obstruction in 63 children and trauma (maxillary fracture) in 3 children, respectively. Of these, 20 children (30.3%) had additional anomalies of the lacrimal system, 21 (31.8%) systemic malformations and 8 out of the 66 children (12.1%) had a family history of nasolacrimal duct obstruction. Since 1985 the surgical procedures have been performed under microsurgery conditions and since 1998 sometimes with a transcanalicular laser-assisted technique. We found a functional success rate (with complete resolution of symptoms) of 90.4% (76 out of 84 lacrimal ducts) over follow-up periods ranging from 1 month to 12 years (average 1.6 years).

CONCLUSION

Patients with persistent dacryocystitis due to congenital nasolacrimal duct obstruction have a prevalence of further nasolacrimal abnormalities and a family history. The dacryocystorhinostomy of infants requires minimal invasive (sometimes laser-assisted) techniques. In the case of persistent dacryocystitis, DCR is indicated after the age of 1 year and has the same success rate in infants as in adults (90-95%).

Endonasal dacryocystorhinostomy in the primary treatment of acute dacryocystitis with abscess formation

PURPOSE

To determine whether endonasal dacryocystorhinostomy may constitute effective primary treatment of acute dacryocystitis with lacrimal sac abscess formation.

METHODS

This was a retrospective review of a series of 24 patients with acute dacryocystitis and lacrimal sac abscess who underwent endonasal dacryocystorhinostomy as a primary procedure. Outcome measures included resolution of signs and symptoms of acute dacryocystitis as well as intranasal ostium patency as assessed by lacrimal irrigation.

RESULTS

Pain was relieved in all patients within 3 days of surgery, and swelling resolved in all patients by 9 days after surgery. Ostium patency, as defined by the absence of epiphora, and free lacrimal irrigation was achieved in 20 (83%) of 24 patients, with follow-up of 27 to 59 months (mean, 40 months). Recurrent epiphora developed in four patients; recurrent dacryocystitis developed in none.

CONCLUSIONS

Endonasal dacryocystorhinostomy may be a useful option in the treatment of acute dacryocystitis with abscess formation.

Endonasal microscopic dacryocystorhinostomy: results and advantages

BACKGROUND

The modern endonasal operative technique of functional fenestration of saccus lacrimalis in the middle nasal meatus (endonasal dacryocystorhinostomy), first described by West in 1910, has been gaining in significance over the past few years. At the VI National Congress of Otorhinolaryngology (1997) we presented for the first time in this country performance of endonasal microscopic dacryocystorhinostomy videotaped and started a routine use of this technique in our department.

OBJECTIVE

We present the results of our 3-year experience with the technique.

MATERIAL AND METHODS

Endonasal microscopic dacryocystorhinostomy was performed in 50 patients (57 operations) without stenting. The effect of the surgery was assessed by comparing the results of control examinations with the preoperative findings using the following criteria: subjective complaints, and objective findings--palpatory test, irrigation according to Anell, endoscopy of the nasal cavities and the neo-ostium.

RESULTS

Statistically significant improvement of specific subjective symptoms was obtained in 78.9%-100%. In 6 cases the closure of the neo-ostium was proven endoscopically.

CONCLUSION

Endonasal microscopic dacryocystorhinostomy preserves intact the normal function of the lacrimal pump, yields excellent cosmetic results and allows simultaneous management of the concomitant sino-nasal pathology. A neo-ostium under 2 mm in diameter can be conducive to postoperative epiphora. A congenital, untreated form of postsaccal stenosis with concomitant dacryocystitis as well as formation of synechiae are factors increasing the possibility of restenosis.

Chronic dacryocystitis in American mucocutaneous leishmaniasis

PURPOSE

This study describes lacrimal tract involvement and surgical outcome in patients with mucocutaneous leishmaniasis.

METHODS

Four patients, ages 20 to 75 years, had nasal lesions resulting from mucocutaneous leishmaniasis and sought treatment for chronic dacryocystitis. Each patient had had lacrimal symptoms since childhood or early adulthood, concomitantly with the development of upper airway lesions. Dacryocystography showed nasolacrimal duct stenosis in all cases on the affected side. Three patients underwent dacryocystorhinostomy (one bilaterally), and one patient had bilateral dacryocystectomy.

RESULTS

Two patients had surgical fistula closure soon after surgery. A sequential endoscopic operation for remotion of a synechia between the fistula and the middle turbinate was successful in one of these patients. Histopathologic analysis of lacrimal sacs and nasal mucous membranes close to the anastomotic site revealed chronic nonspecific inflammatory process and negative immunohistochemistry for Leishmania.

CONCLUSIONS

Dacryocystitis may result from nasal mucocutaneous leishmaniasis. The surgical outcome was unsatisfactory in one of the four patients.

[Analysis of the efficacy of early probing in the treatment of symptomatic congenital lacrimal duct obstruction in infants. Apropos of 92 cases]

INTRODUCTION

Nasolacrimal duct obstruction (NLDO) is a common clinical problem (5 to 6% of newborns). Dacryostenosis is a partial or complete block in the nasolacrimal duct.

PATIENTS AND METHODS

The records of 68 patients (92 cases) of NLDO with/without mucocele were reviewed. The probing was performed early and according to the same technique.

RESULTS

The age at the time of probing ranged from 0 to 7 months (mean 4.6 months). The cure rate was 91.3% and the failure rate was 8.70%.

DISCUSSION

Our results are consistent with other reports in the literature. The cure rate was higher with a earlier probing and was good after a second tentative of probing. A multiple obstruction of nasolacrimal system was cause of a failure. This was not the case with mucocele. The optimal timing of the probing is discussed in this report and we preferred to perform the probing to 4 at 6 months.

CONCLUSION

We showed a high cure rate with early probing in our series. These results should be confirmed by a prospective randomised study (in process in our institution).

Nasolacrimal duct obstruction and dacryocystocele associated with a concha bullosa mucocele

PURPOSE

To describe the rare occurrence of a concha bullosa mucocele producing secondary nasolacrimal duct obstruction and dacryocystocele.

DESIGN

Case report.

PARTICIPANT

Forty-two-year-old man with 6-month history of left medial canthal mass.

INTERVENTION

Clinical evaluation with lacrimal testing, computed tomography and surgical exploration, including biopsy, dacryocystorhinostomy, and excision/marsupialization of the middle turbinate concha bullosa mucocele were performed.

RESULTS

The medial canthal mass was confirmed to be a dacryocystocele associated with nasolacrimal duct obstruction and bone destruction caused by concha bullosa mucocele.

CONCLUSIONS

Concha bullosa mucoceles are uncommon and even more rarely can produce secondary nasolacrimal duct obstruction and dacryocystocele formation. The clinical and radiologic features may mimic a lacrimal sac malignancy.

[20 MHz ultrasound diagnosis in chronic canaliculitis]

BACKGROUND

High frequency sonography is used with a medium frequency of 50 to 100 MHz for non-invasive examination of the anterior eye segment. 20-MHz probes are considered to be a cost-efficient alternative, with a lower resolution and a higher penetration depth. We examined the value of the 20-MHz probe in diagnosing chronic canaliculitis.

CASE REPORT

A 50-year-old woman was evaluated for a chronic canaliculitis. A pathognomonic sign of the chronic canaliculitis was the detection of concrements by high-resolution ultrasound. Grains measuring 1-2 mm in diameter could be shown in an ecstatic canaliculus with 20-MHz sonography. The high-resolution sonography showed the extent of the ectasia of the canaliculus and was therefore useful in planing the operative strategy.

CONCLUSION

The spectrum of possibilities in diagnosing chronic canaliculitis is broadened with this diagnostic tool. Specially when characteristic symptoms are missing, the 20-MHz probe may be useful in diagnosing patients with chronic canaliculitis.

[Endonasal dacryocystorhinostomy (DCR) with protected drill]

PURPOSE

To analyze the interest of protected drills to perform endoscopic endonasal DCR.

MATERIAL AND METHODS

[corrected] Fifty patients suffering from chronic epiphora were operated successively. None of those patients had had prior nasal surgery. The same surgeons (BF and ER) did the surgical procedure for all the cases. The technical steps were: endoscopic visualization of the middle meatus and evaluation of the anatomic variations of the nose; identification of the lacrymal bag with a 1 mm light in the canaliculus; unciformectomy; the maxillary bone was drilled with a 3.2 mm bit (straightshot Xomed), protected and irrigated; the lacrymal bag was opened by cissors and the flap was pushed in the ethmoid and coagulated.

RESULTS

The suction-irrigation system was efficient to clean the surgical site, with a good endoscopic control. The protected bit didn't damage the 4-mm optics and the septal wall mucosa, even in narrow noses. The staightshot bit (Xomed) was tough enough to drill the maxillary bone in only 68 % of the surgical cases. In 28 % the drilling was unsatisfactory and in 4 % it was inefficient. The functional results at 6 month were good in 85 %. There was no difference between normal and narrow noses.

CONCLUSION

The concept of protected bits perfectly matches the endoscopic endonasal DCR. The visual comfort and security of the surgical procedure are increased. Short term results are equivalent to external DCR, but are rather inefficient and expensive.

Retained stenting material: an unusual cause of dacryocystorhinostomy failure

OBJECTIVE

To highlight a troubling cause of dacryocystorhinostomy (DCR) failure and to alert ophthalmologists to the potential problems that can result when stenting material is not removed and becomes retained after DCR.

DESIGN

Consecutive noncomparative case series.

PARTICIPANTS

Twelve patients who underwent revision DCR from February 1994 to January 1997.

INTERVENTION

Endoscopic DCR, pre- and postoperative nasal endoscopy, preoperative computerized tomography (CT), and pre- and postoperative Jones testing.

RESULTS

Fourteen revision endoscopic procedures were performed on 12 patients with recurrent epiphora following DCR. Failure was due to retained stenting material in six patients, a small bony rhinostomy in three patients, excessive scar formation within the rhinostomy in two patients, and improper location of the rhinostomy in one patient. Preoperative endoscopy and CT scan each correctly identified the retained sponge or tubing in four of six patients.

CONCLUSIONS

Fastening a small sponge to Silastic tubing and positioning it within the DCR site in an attempt to retard DCR stenosis can be associated with a poor outcome and should be avoided. The nasal endoscope provided excellent visualization of pathology within the lacrimal sac and was a valuable tool. Retained stenting material should be considered in patients with persistent epiphora following DCR or intubation prior to any decision to commit a patient to permanent Jones tube placement.

[Treatment for chronic dacryocystitis by probing through naso-lacrimal duct under endoscopy]

OBJECTIVE

To determine the possibility of curing chronic dacryocystitis by probing through naso-lacrimal duct under endoscopy.

METHOD

30 adult eyes with chronic dacryocystitis were divided into two groups: 20 treated under endoscopy as endoscopy group and 10 under rhinoscope as control.

RESULT

In endoscopy group, treatment in all 20 eyes successed at the first time, but in control group only in 8 of the 10 eyes successed at the first time and the other 2 needed second surgery.

CONCLUSION

Treatment for chronic dacryocystitis by probing through naso-lacrimal duct under endoscopy is better.

Mucocele in an orbitoethmoidal (Haller's) cell (accidentally combined with acute contralateral dacryocystitis)

Haller's cells--according to recent terminology now called orbitoethmoidal cells (OEC)--are defined as anterior or posterior ethmoidal cells that have developed into the orbital floor. They can be excessively pneumatized and thus contribute to obstruction of the ostiomeatal complex area. We present the case of a 42 year old white male, who was admitted for treatment of an acute dacryocystitis on the right side. The CT scan revealed moderate sinusitis of the right ethmoid and maxillary sinuses and coincidentally a mucocele in an OEC on the left side. An endoscopic dacryocystorhinostomy on the right and a revision of the mucocele on the left side were performed in the same sitting. We consider both indications--stenosis of the nasolacrimal duct as well as mucoceles rewarding indications for endoscopic surgery. An external approach to the nasolacrimal duct in this case would have been problematic, as the external skin and soft tissue covering the duct already showed severe inflammatory changes. The operation of the up until that time asymptomatic mucocele was of prophylactic character. To our knowledge this is the first report of a mucocele developing in an OEC in the literature.

Lacrimal gland abscess: two case reports

BACKGROUND

Bacterial dacryoadenitis is rare and suppuration leading to abscess formation within the lacrimal gland has been very rarely reported in the antibiotic era.

METHODS

The medical records and investigation results, including computed tomography (CT), of two patients with lacrimal gland abscess were reviewed.

RESULTS

Two cases of lacrimal gland abscess, one a 28-year-old male and the other a 64-year-old female, are described. Both demonstrated a characteristic low-density area within an enlarged lacrimal gland on CT. The first case had been treated with antibiotics and the abscess, when drained, was sterile. The second case settled spontaneously. Neither patient suffered any sequelae of dry eye.

CONCLUSIONS

Although rare, lacrimal gland abscess may still occur and may require surgical drainage if spontaneous resolution does not occur.

Oncocytic adenomatous hyperplasia of the lacrimal sac: a case report and review of the literature

Oncocytic tumors of the lacrimal sac are very rare, with only 21 cases documented in the world literature. The authors report a 75-year-old woman who sought treatment for recurrent dacryocystitis and a palpable mass in the left medial canthal area. The patient underwent surgery for removal of a suspected lacrimal sac cancer, but pathologic findings indicated benign oncocytic adenomatous hyperplasia. Complete removal of the tumor and long-term follow-up are necessary in patients with lacrimal sac oncocytic lesions. The authors discuss the characteristic features of ocular adnexal oncocytic lesions and review the literature.

[Radiation exposure of radiation-sensitive risk organs--ocular lens, parotid gland, thyroid gland--in dacryocystography and therapy]

PURPOSE

Evaluation of radiation dose to the radiosensitive head and neck organs and tissues-ocular lens, parotid and thyroid glands--during dacryocystography and fluoroscopy--guided dacryocystoplasty (DCP).

METHOD

Radiation dose was determined in an Alderson Rando phantom and in 13 patients. Radiation dose was measured directly using Ca-F2-thermoluminescent dosimetry crystals (TLD) which were placed on each eyelid, parotid gland and thyroid gland.

RESULTS

The mean radiation dose to the lens placed next to the path of radiation was 6.58 mGy in the Alderson-Rando phantom and 5.43 mGy in patients during DCP. The mean radiation dose to the contralateral lens was 1.37 mGy and 1.7 mGy to the parotid gland placed next to the x-ray tube. Radiation dose to the thyroid gland was max. 0.4 mGy during DCP.

CONCLUSION

Radiation dose to the ocular lens, parotid gland and thyroid gland during fluoroscopy-guided DCP was 25 times higher than during diagnostic dacryocystography. The radiation dose to radiosensitive head and neck organs and tissues during fluoroscopy-guided DCP is much below the threshold dose for ocular lens cataract.