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Utilization Patterns for Diagnostic Imaging in the Evaluation of Epiphora Due to Lacrimal Obstruction: A National Survey

Nagi, Kundandeep S. M.D.; Meyer, Dale R. M.D., F.A.C.S.

Ophthalmic Plastic & Reconstructive Surgery: May-June 2010 - Volume 26 - Issue 3 - p 168-171
doi: 10.1097/IOP.0b013e3181b8c747
Original Articles
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Purpose: To evaluate current physician patterns for diagnostic lacrimal imaging in patients with epiphora related to lacrimal obstruction.

Methods: An invitation was sent to members of the American Society of Ophthalmic Plastic and Reconstruction Surgeons in September 2008 to participate in a short web-based questionnaire. The survey focused on basic demographic information and the use and indications for various types of diagnostic imaging modalities in the evaluation of epiphora. Specific imaging modalities queried included facial x-ray, lacrimal ultrasound, CT, MRI, contrast dacryocystography, and radionuclide dacyroscintigraphy. Responses were analyzed using standard statistical methods.

Results: Less than 5% of respondents use lacrimal imaging of any type for the majority of their patients with epiphora thought due to lacrimal obstruction. When lacrimal imaging was used, CT was the most common type overall. CT was the preferred modality for all indications surveyed when an imaging modality was elected, except when confirming the site or type of obstruction in which case dacryocystography was preferred. Excluding CT, a majority of respondents indicated that they “never” (0%) used any of the specific lacrimal imaging studies surveyed, including dacyroscintigraphy, which was never used by over 75% of respondents.

Conclusions: The low overall imaging rate suggests that most lacrimal problems are diagnosed with office testing alone. For most specific indications, respondents indicated a preference for CT. No difference in imaging frequency was found for the majority of our respondents when considering external versus endonasal dacryocystorhinostomy. Most respondents favored external approach dacryocystorhinostomy.

The overall frequency of lacrimal imaging for epiphora secondary to lacrimal obstruction in our study group was low. When imaging was elected, CT was preferred for most indications.

Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Albany (Slingerlands), New York, U.S.A. The overall frequency of lacrimal imaging for epiphora secondary to lacrimal obstruction in our study group was low. When imaging was elected, CT was preferred for most indications.

Accepted for publication July 18, 2009.

No authors have any financial or conflicting interests to disclose.

Address correspondence and reprint requests to Dale R. Meyer, M.D., F.A.C.S., Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, 1220 New Scotland Road, Suite 302, Albany (Slingerlands), NY 12159, U.S.A. E-mail: meyerd@mail.amc.edu

©2010The American Society of Opthalmic Plastic and Reconstructive Surgery, Inc.