THE PECULIAR FEATURES OF THE PERFORMANCE AND INTERPRETATION OF THE RESULTS OF THE CONTRAST-ENHANCED X-RAY EXAMINATION OF THE LACRIMAL TRACT IN THE CHILDREN

Introduction. The contrast-enhanced X-ray study makes up an important stage in diagnostics of the pathological changes in the lacrimal pathways carried out after the ophthalmological examination of the patients complaining of lacrimation, lacrimal channel test, and washing of the lacrimal passages. Aim. The objective of the present study was to evaluate the diagnostic value and significance of the contrast-enhanced X-ray study of the lacrimal passages as a component of the algorithm for the examination of the pathologically changed lacrimal tract. Material and methods. The present study included the analysis of the results obtained in the contrast-enhanced X-ray study carried out during the period from 2014 to 2015; a total of 217 patients suffering from tear shedding were involved in the study. We developed indications and contraindications for the application of the technique under consideration. In accordance with the proposed guidelines for the purpose, the adult patients should be examined with the use of the contrast-enhanced X-ray method under local anesthesia and most of the young children under general anesthesia. It is important to wash lacrimal pathways immediately before the contrast administration. All X-ray contrast agents contain iodine; therefore, all the patients need to be preliminarily tested for the presence of allergy to iodine. Visualization is performed in the nasal-frontal, nasal-mental, and lateral projections. The children are examined in the supine position when lying face up. The variants of the normal X-ray picture of the lacrimal pathways that are important to know for the correct interpretation of the data obtained during the examination are described. Normally, the contrast material completely disappears from the lacrimal pathways within a few seconds to 4-7 minutes after its the administration to the patient. Results. The results of the present contrast-enhanced X-ray study that involved 217 patients examined in 2014-201) provide information about the levels of strictures in the lacrimal passages of adults and children. If the tumour is localized in the inferior internal angle of the orbit, the contrast-enhanced X-ray examination of the lacrimal pathways should be preferred because it makes possible the layer by layer assessment of the state of the bony orbital walls, paranasal sinuses, and soft tissue structures; moreover, it allows to follow up the spread of the tumor along the lacrimal tract. Conclusion. The contrast-enhanced X-ray examination of the lacrimal passages provides a powerful tool for the diagnostics of the diseases of the lacrimal pathways. Specifically, it permits to identify the lacrimal tract strictures at the entrance to the lacrimal sac that prove to occur in 29% and 10% of the adult patients and children respectively and to detect the enlargement of the lacrimal sac in 15% of the adults and in 25% of the children. The method is indispensable for the characteristic of the state of the nasolacrimal duct after an injury.

children, contrast-enhanced X-ray examination, lacrimal tract, lacrimation