Dacryocystogram Dacryocystogram (DCR)(DCR)

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Lacrimal GlandLacrimal Gland

•The lacrimal gland produces tears which keep the eye moist.

•The tears enter the eye from the upper outer sector of the eye 

•The tears travel through the tear drainage system into the nose.

Blocked Lacrimal GlandBlocked Lacrimal Gland

•Sometimes, the lower tear duct becomes blocked. This produces a watery eye.

•Correction of a blocked tear duct requires surgery.

Patient ScenarioPatient Scenario

This 59 year-old woman had had bilateral This 59 year-old woman had had bilateral endonasal dacryocystorhinostomy (DCR).endonasal dacryocystorhinostomy (DCR).

She was symptom free for about 6 months, She was symptom free for about 6 months, but returned to the clinic recently complaining but returned to the clinic recently complaining of right epiphora. of right epiphora.

There was a blockage in the right side but There was a blockage in the right side but left side was fine. left side was fine.

She later underwent DCR with good result.She later underwent DCR with good result.

Left DCG showing lacrimal sac filling  followed by Left DCG showing lacrimal sac filling  followed by spillage of the dye into the nasal cavity through spillage of the dye into the nasal cavity through

the dacryocystorhinostomythe dacryocystorhinostomy

Right DCG showing lacrimal sac filling without drainage Right DCG showing lacrimal sac filling without drainage into the nasal cavity. into the nasal cavity.

In the last frame, dye shows up in the lower lid margin In the last frame, dye shows up in the lower lid margin from regurgitation.from regurgitation.

CT scan showing normal osteomeatal complex. CT scan showing normal osteomeatal complex. Sinuses are well ventilated.Sinuses are well ventilated.

CT scan showing rhinosinusitis with a blocked CT scan showing rhinosinusitis with a blocked osteomeatal complex and secondary infection in osteomeatal complex and secondary infection in

the maxillary sinuses.the maxillary sinuses.

Findings:Findings: Serial axial images through the orbit without contrast show Serial axial images through the orbit without contrast show bilateral masses involving the lacrimal glands and extending both bilateral masses involving the lacrimal glands and extending both superiorly and laterally to the globe. Bilateral protrusion of the eyeballs is superiorly and laterally to the globe. Bilateral protrusion of the eyeballs is noted.noted.

Clinical Clinical History:History: 65 year 65 year old male with old male with bilateral orbital bilateral orbital masses and a masses and a history of non-history of non-Hodgkin’s Hodgkin’s lymphoma and lymphoma and lung lung carcinoma.carcinoma.

Diagnosis:Diagnosis: Bilateral lacrimal gland Bilateral lacrimal gland enlargement. enlargement.

Benign lymphoidBenign lymphoid

EpiphoraEpiphora

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Lacrimal Dilator

Inflation Device

9mm Transnasal Lacrimal Duct Balloon

Catheter

5 mm Lacrimal Duct Balloon CatheterBalloon Catheter

3 mm Lacrimal Duct Balloon Catheter

2 mm Lacrimal Duct Balloon Catheter

Tear Duct TubesTear Duct Tubes

Standard Set Assorted Set Special Set

Disorder Correction descriptionDisorder Correction description priceprice

GloucomaGloucoma 700$  for each eye700$  for each eye

CataractCataract 700$  for each eye700$  for each eye

LASIKLASIK 700$  for both eyes700$  for both eyes

Retinal Detachment SurgeryRetinal Detachment Surgery 1200$1200$

Cornea transplant (Penetrating Cornea transplant (Penetrating keratoplasty)keratoplasty)

1500$1500$

Dacryocystorhinostomy (DCR)Dacryocystorhinostomy (DCR) 600$600$

wwwtehranlasik.com/correction/Dacry.htm