This 54 year-old woman complained of epiphora
worse in the right than the left eye. Syringing of the right lower punctum
produced regurgitation from the upper punctum but water can be felt in
the throat. The left lower punctum was syringed with little difficulty.
A DCG was performed which showed no obstruction in both nasolacrimal system.
Lacrimal sintigrams were ordered and the radiologist's report was as followed:
The lacrimal sintigrams showed early
normal excretion of tracer through the superior and inferior canaliculi
into the common canaliculus. Progression down the first centimetre or so
occurred more rapidly on the left but some tracer was noted as far as the
middle third of the right nasal lacrimal duct but the majority remained
in the proximal centimetre of this structure. On the left side the tracer
was seen to enter the nasal cavity at 40 minutes. On the right side tracer
was never seen beyond the middle third of the nasal lacrimal duct with
the majority of tracer being held up much more proximal to this indicating
an obstructive source for the patient's epiphora.