| Title | The use of Dacryocystography in the management and treatment of Congenital Lacrimal fistula |
| Submitted by | Bansri Lakhani |
| Abstract Number | 351 |
| 19-273 | |
| Review Result | poster presentation |
| Purpose | Congenital lacrimal fistulae are accessory ducts between the lacrimal drainage system and the skin, often referred to as accessory puncti. The nasolacrimal apparatus along with any abnormalities can be assessed using Dacryocystography (DSDCG). |
| Methods | A single centre retrospective, observational case series of 6 eyes (5 patients) with congenital lacrimal fistula. |
| Results | Out of the 6 Lacrimal fistulas: 1 was bilateral, 3 were right sided and 1 was left sided. There were 3 male and 2 female patients, the median age of presentation was 2 years ranging from 6 months to 9 years.
All 6-fistula presented with epiphora and discharge. All patients had no or very limited Fluorescein dye passage through the lacrimal system. (Fluorescein dye test: FDDT). There were no documented episodes of dacryocystitis. DSDCG investigation was carried out for all patients. 4 lacrimal systems were patent with no obstruction, 2 had distal obstructions with no flow beyond the valve of Hasner. 5 out of 6 accessory puncta originated from the canaliculus: 2 from the superior canaliculus and 3 from the inferior canaliculus. 1 patient had a lacrimal sac fistula. All 6 fistulas underwent fistulectomy surgery, 5 with self-retaining monocalicular silicone tubing and one with MiniMonoka tube. DSDCG was carried out intra-operatively and showed that 5 out of 6 fistulas resolved following intubation. Post-operatively all lacrimal systems were patent with complete draining or minimal limitation of passage of fluorescein dye through the lacrimal system. In the oldest patient (9 years), the fistula sealed following intubation but there was development of bilateral canalicular strictures which required repeat lacrimal intubation. There were no documented post-operative complications and all children were followed up in clinic for at-least 12 months. |
| Conclusion | The use of DSDCG in these cases helped to visualise the anatomical location of the fistula and diagnose co-pathology such as obstruction in 2 of the lacrimal systems. The information from the DSDCG influenced further patient management with fistulectomy combined with syringe and probing +/- lacrimal intubation. Further assessment with DSDCG allows confirmation of fistula closure. |
Additional Authors
| Last name | Initials | City / Hospital | Department |
|---|---|---|---|
| Rajput | R | Queen’s Medical Centre | Ophthalmology |
| Tambe | K | Queen’s Medical Centre | Ophthalmology |
