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Abstract ID: 24-128

Utility of Computed Tomography – Dacryocystography in the Management of Traumatic Secondary Acquired Nasolacrimal Obstruction

Nandini Bothra


To evaluate the role of Computed Tomography – Dacryocystography (CT – DCG) in the Management of Traumatic Secondary Acquired Nasolacrimal Obstruction (SALDO).


Retrospective interventional case series with 85 lacrimal drainage systems (LDS) of 79 patients diagnosed with Traumatic SALDO, presenting to the dacryology clinic at a tertiary center between Jan 2019 – June 2023. Only patients who underwent pre-operative CT-DCG were included. Lacrimal intervention included endoscopic dacryocystorhinostomy (DCR), external DCR, or dacryocystectomy (DCT). Application of Mitomycin – C 0.04% and bicanalicular intubation were performed for all DCRs. Successful outcome was defined as patent irrigation (anatomic success), and nil to minimal epiphora (functional success), or absence of discharge in cases of DCT.


The median age at presentation was 29 years. Majority were males (88.6%). Naso-orbito-ethmoid fractures were noted in 53 cases (62.4%), orbital in 54 cases (63.5%) of which 27 (41.5%) were medial wall fractures. Cribriform plate was damaged in 5 (6%) cases. Fractures involving the lacrimal sac fossa and nasolacrimal duct (NLD) were seen in 26 (30.5%) and 10 (11.7%) cases, respectively. CT – DCG showed a dilated sac in 60 (70.5%) cases, shrunken and fibrosed in 13 (15.2%), while the sac could not be visualized in 3 (3.5%) cases. Displacement of the lacrimal sac from the fossa was seen in 51 (64%) cases [posteriorly – 21 (41%), superiorly 18 (35%), inferiorly 5 (9.8%), anteriorly 8 (15.6%)]. Lacrimal sac diverticula in 4, and hyperostosis in 33 (39%) cases was present. Lacrimal surgery was performed in 63 (74%) LDS [endoscopic DCR -most common (29, 46%), external DCR (26, 41%) DCT (8, 12.6%)]. CT – DCG findings corroborated with intra-operative findings in 60 (95%) cases. Successful outcome was achieved in 62 cases (98.4%) while 1 patient underwent revision endoscopic DCR.


A pre-operative CT – DCG in Traumatic SALDO facilitates surgical planning and anticipates intra-operative challenges, yielding successful outcomes, and should be performed for all cases of traumatic SALDO.

Additional Authors

Ayushi Agarwal – LV Prasad Eye Institute

Mohammad Javed Ali – LV Prasad Eye Institute

– LV Prasad Eye Institute