Accuracy of the Lacrimal Syringing Test in Relation to Dacryocystography and Dacryoendoscopy

Abstract

Purpose

This study aimed to evaluate the accuracy of the lacrimal syringing test (syringing) in relation to dacryocystography (DCG) and dacryoendoscopy (DE) in lacrimal pathway (LP) obstruction.

Methods

We retrospectively reviewed 101 patients (188 LPs) who underwent syringing, cone-beam computed tomography (CBCT)-DCG, and DE to diagnose the degree and site of LP obstruction. The degree of obstruction was classified into patent, partial obstruction, and complete obstruction. The degree of LP obstruction was determined by combining the findings of DE and CBCT-DCG and was designated as DCG+DE. When differentiating complete or partial obstruction on DE was uncertain, complete or partial obstruction was assigned if the DCG showed evidence of contrast media obstruction or passage, respectively. The consistency between syringing and DCG+DE was evaluated by calculating the weighted kappa coefficient.

Results

The sensitivity and specificity of syringing were 94% and 89%, respectively. The weighted Cohen’s kappa value of agreement between syringing and DCG+DE was κ = 0.73 (SE = 0.04, 95% confidence interval [CI]: 0.66–0.80, p < 0.01). When divided into presaccal and postsaccal obstruction categories, the kappa values were κ = 0.40 (SE = 0.11, 95% CI: 0.19–0.62, p < 0.01) and 0.55 (SE = 0.09, 95% CI: 0.37–0.73, p < 0.01), respectively. Furthermore, when limited to common canaliculus obstruction (stenoses), which accounted for 78% (46 LPs) of the total presaccal obstructions, the kappa value was κ = 0.29 (SE = 0.12, 95% CI: 0.05–0.54, p = 0.021), which demonstrated the lowest consistency between syringing and DCG+DE.

Conclusion

Syringing was “substantially” in agreement with DCG+DE in detecting the degree of LP obstruction. Moreover, syringing was a sufficiently sensitive and specific test when performed by an experienced clinician. However, distinguishing between complete and partial obstructions by syringing was sometimes difficult, particularly in the common canaliculus obstruction (stenosis).

Keywords:

• epiphora
• nasolacrimal duct
• lacrimal passage obstruction
• stenosis
• lacrimal drainage system
• lacrimal sac
• lacrimal syringing
• irrigation
• dacryocystography
• dacryoendoscopy
• weighted kappa coefficient

Abbreviations

CBCT, cone-beam computed tomography; CCS, common canalicular stenosis; CCO, common canalicular obstruction; DCG, dacryocystography; DCR, dacryocystorhinostomy; DE, dacryoendoscopy; ELDR, endoluminal lacrimal duct recanalization; LP, lacrimal pathway; NLD, nasolacrimal duct; SD, standard deviation; SE, standard error.

Data Sharing Statement

The datasets analyzed in this study are available from the corresponding author (JN) on reasonable requests.

Ethics Approval and Consent to Participate

The protocol and consent forms for the study were approved by the institutional review board of Ehime University (ethical approval no. 1601003). The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN 000025180). Each patient provided written informed consent before registration. All procedures used in this study were performed under the tenets of the Declaration of Helsinki.

Acknowledgments

The authors would like to express their sincere gratitude to Dr. Toru Suzuki for his continuous scientific mentoring and instructions.

Disclosure

The authors declare that they do not have any competing interests and are solely responsible for the content and writing of the paper.

Additional information

Funding

The study was supported by the Japan Society for the Promotion of Science Postdoctoral Fellowship for Research Abroad (Kaitoku-NIH, #24112 to JN). The funding source had no role in the study design, data collection, analysis, publication decisions, or manuscript preparation.