Computed Tomography - Dacryocystography Guided Management of Traumatic Secondary Acquired Lacrimal Duct Obstruction: SALDO Update Study (SUP) - Paper V

Purpose: To evaluate the role of computed tomography-dacryocystography (CT-DCG) in the management of traumatic secondary acquired lacrimal duct obstruction (SALDO) and study its correlation with the intra-operative findings.

Methods: Retrospective interventional case series. Eighty-five lacrimal drainage systems (LDS) of 79 patients diagnosed with traumatic SALDO, who underwent pre-operative CT-DCG, between January 2019 and June 2023, were analyzed. The lacrimal intervention included endoscopic dacryocystorhinostomy (En-DCR), external DCR(Ex-DCR), or dacryocystectomy (DCT) based on the clinical presentation, CT-DCG findings, local and systemic factors. Anatomical and functional outcomes were assessed.

Results: Eighty-five LDS of 79 patients with a mean age of 32 years and male predominance (n = 70, 89%) were studied. The median time of trauma to clinical presentation was 12 months and the duration of epiphora was 8 months. Naso-orbito-ethmoid fractures were seen in 56 (66%) cases and cribriform plate fracture in 5 (6%) patients. CT-DCG revealed a dilated sac in 60 (71%) LDS, shrunken in 13 (15%), while the sac could not be visualized in 3 (4%) LDS. Relative lacrimal sac displacement was seen in 51 (64%) LDS of which 21 (41%) were displaced posteriorly, 18 (35%) superiorly, 5 (10%) inferiorly, and 8 (16%) into the anterior orbit. Sac - duct junction was the most common location of obstruction (n = 78, 92%). At a mean follow up period of 3.5 months, 62 of the 63 LDS surgeries performed (98%) demonstrated anatomical and functional success. Of the 63 operated LDS, CT-DCG findings corroborated with intra-operative findings in 60 (95%) LDS.

Conclusion: CT-DCG helps decide the surgical approach, possible complications, intra-operative course and hence has the potential to influence the outcomes. A thorough understanding of CT-DCG, therefore, should be a part of a Dacryologist's armamentarium for managing complex SALDO.