The consistency of diagnostic findings among lacrimal syringing, dacryocystography, and dacryoendoscopy in lacrimal drainage system obstruction

Abstract Aim To investigate the consistency of diagnostic findings in lacrimal syringing, dacryocystography (DCG), and dacryoendoscopy in the obstruction of the lacrimal drainage system (LDS). Methods We retrospectively examined 113 patients (211 LDS) who underwent syringing, DCG, and dacryoendoscopy to evaluate LDS obstruction. LDS obstruction was compared by classifying grade and site into three levels, respectively. The diagnostic consistency between the examinations was assessed by determining the weighted kappa value. Results A total of 25 male (49 LDS) and 88 female patients (162 LDS) were included in this study. Obstructions were observed in 77.4%, 60.0%, and 81.3% of LDS by syringing, DCG, and dacryoendoscopy, respectively. Regarding the agreement in obstruction grade, Cohen’s kappa value for DCG and dacryoendoscopy was 0.65 (95% confidence interval [CI]: 0.56–0.74). Although DCG diagnosed as patent in 38.4% of all LDS, 47.9% of them revealed partial or complete obstruction by dacryoendoscopy. Meanwhile, DCG and dacryoendoscopy showed consistency in the obstruction site in 77.9% of LDS. When discrepancies were observed between syringing and dacryoendoscopy in detecting the obstruction site, the combined diagnosis of syringing and DCG reached dacryoendoscopy findings at the 99% level. Conclusions “Substantial” agreements were found among the three examinations in diagnosing obstruction grade and site (Fleiss κ > 0.6 for both). Then, the highest agreement was observed between syringing and dacryoendoscopy in determining the obstruction site (κ = 0.7). The lowest agreements were observed between syringing and DCG in diagnosing the obstruction grade and site (κ = 0.55 for both).