A Feasibility Study to Develop a Protocol for Functional Lacrimal Magnetic Resonance Imaging

Tear drainage delay is a common problem that causes a watery eye. This can impair activities of daily living such as reading and driving, can be a huge nuisance requiring continual dabbing with a tissue and can cause infections and abscesses of the tear drainage system. The current, standard investigations for tear drainage delay have significant limitations with two separate scans in separate departments being required. A functional MRI scan would be able to combine these two scans and provide both better anatomical and functional detail than each one respectively. This would have several major benefits:

• Improved diagnostic information to guide the treatment choice
• Reduced scan resource usage as one scan would provide all the required functional anatomical and functional information.
• Improved patient convenience
• Improved safety as radiation is used for CT DCG, where MRI The study involves investigation of both controls with normal tear drainage and individuals with known tear drainage delay. Both groups are required for the development of the protocol as the speed of tear transit will differ greatly which will facilitate optimisation of the MRI scan protocol. This will also provide preliminary data on the speed of tear passage in a normal lacrimal drainage system and in an impaired system.

Several other functional lacrimal drainage MRI studies have been done. However, a clear protocol has not been developed and there is no data on normal and abnormal MRI appearances and tear transit times.

The normal standard of care will not be delayed by this investigation as it will be conducted while patients are awaiting other lacrimal investigations (DCG and DSG) or lacrimal surgery, none of which would be affected by this study.

Inclusion criteria

• Lacrimal drainage disease participants (n=5)

• Symptomatic epiphora (tearing)
• Nasolacrimal drainage dysfunction confirmed by the following characteristics:

• An abnormal delay of tear transit on DSG
• A normal DCG and lacrimal syringing investigation
• Normal eyelid and punctal anatomy

Controls

• No epiphora
• Normal lacrimal syringing in clinic.

Exclusion criteria

• Age under 18
• Renal function <30mL/min/1.73m2
• Contra-indications to MRI e.g. electronic or metal implants, severe claustrophobia
• Known adverse reactions to contrast agents
• Pregnancy

Exclusion criteria

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