Retrograde dacryocystography (RDC) utilizing a round-tipped needle

Because the application of conventional anterograde dacryocystography has been restricted in cases with an intact lacrimal punctum, the indications are rather limited. The authors developed a new method for retrograde dacryocystography (RDC) using a hand-made round-tipped needle inserted directly into the orifice of the nasolacrimal duct. A 60 mm long aluminum tube (3 mm in diameter) was used to prepare the round-tipped needle. The distal portion of the tube was bent to an angle of about 80 degrees. The tip was then coated with synthetic resin adhesive to make it round. Following the insertion of the round-tipped needle directly into the inferior meatus, the tip was moved back and forth to find the orifice without visual observation. The complete insertion of the tip of the needle into the nasolacrimal duct was recognized by a fixed sensation of the tip. Contrast medium was then injected, and PA radiography was carried out. In the present paper, the authors report the usefulness of RDC, which is applicable even in cases of injury or obstruction in the upper lacrimal system. In 16 of 20 patients, the quality of the RDC images was judged as excellent. RDC can be carried out within a few seconds after acquiring the technical skills, and is thought to be a useful method, especially in cases of upper lacrimal injury.