A Comprehensive Review of Dacryoscintigraphy: Part II—Limitations and Future Direction

Purpose: This is the second part of the comprehensive review of dacryoscintigraphy (DSG), which evaluates the major factors that hinder the routine utility of DSG and possible future directions to improve the technology. Methods: The authors performed a PubMed/Medline search of all articles published in English and other languages on DSG. The data analyzed included the techniques and indications of DSG, the interpretation of the results, and the clinical utility and limitations of DSG. Results: The present major review suggests that the findings of DSG do not add significantly to a thorough clinical examination. The diagnostic reliability of DSG is limited by the lack of standardization, poor anatomical resolution, poor quality of images, intra and interobserver variability, low specificity, insufficient correlation with clinical findings, the inability to distinguish stenosis from obstructions, and the inability to assess the results of lacrimal surgery. These limitations raise concerns regarding any justification for its use in everyday lacrimal practice. Conclusions: DSG is not routinely used by the vast majority of lacrimal surgeons worldwide given that in most cases, it does not profoundly impact clinical decision-making. The DSG technology needs to be improved. Hybrid camera devices with higher resolution, and new radiotracers that simulate the biological and chemical properties of tears may help pave the way forward.