{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T10:06:20Z","timestamp":1780653980236,"version":"3.54.1"},"reference-count":18,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Chronic epiphora is a common ophthalmic complaint with multifactorial etiology, including both structural obstruction of the nasolacrimal drainage system (NLDS) and functional or ocular surface\u2013related causes. Accurate differentiation between these conditions is essential for appropriate management, yet conventional diagnostic methods provide limited anatomical detail. The complementary role of advanced imaging in routine clinical decision-making remains incompletely defined. Methods: In this retrospective observational study, 127 patients with chronic epiphora who underwent CT-DCG as part of routine clinical care were analyzed. CT-DCG was performed in patients with suspected NLDS involvement. Clinical, functional, and imaging data were analyzed, and multivariable logistic regression was used to identify factors associated with surgical management. Results: Distal NLDS involvement was the most common CT-DCG finding. Purulent discharge and longer symptom duration were associated with surgical management. Duration of symptoms remained independently associated with surgical management (OR 1.04 per month, 95% CI 1.02\u20131.06, p &lt; 0.001), while purulent discharge was also strongly associated, although the confidence interval was wide. Functional parameters, including fluorescein dye disappearance test and dry eye syndrome, were not independently associated. The model demonstrated good discrimination (AUC 0.89). Conclusions: CT-DCG provides detailed anatomical assessment of lacrimal drainage abnormalities in patients with chronic epiphora and may complement standard clinical evaluation in selected cases with suspected structural pathology. However, CT-DCG findings were analyzed primarily descriptively because several imaging subgroups were small. Clinical features such as prolonged symptom duration and purulent discharge were associated with surgical management, whereas functional tests alone showed limited independent association.<\/jats:p>","DOI":"10.3390\/diagnostics16111740","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T08:43:04Z","timestamp":1780648984000},"page":"1740","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Predictors of Surgical Management in Patients with Chronic Epiphora: A CT-DCG\u2013Supported Analysis"],"prefix":"10.3390","volume":"16","author":[{"given":"Akerke","family":"Makenkyzy","sequence":"first","affiliation":[{"name":"Department of Eye Diseases, NJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanar","family":"Abdrakhmanova","sequence":"additional","affiliation":[{"name":"Department of Radiology, NJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raushan","family":"Rakhimzhanova","sequence":"additional","affiliation":[{"name":"Department of Radiology, NJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynet","family":"Akhmedyanova","sequence":"additional","affiliation":[{"name":"Department of Eye Diseases, NJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira","family":"Kadralieva","sequence":"additional","affiliation":[{"name":"Department of Eye Diseases, NJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aigerim","family":"Tuletova","sequence":"additional","affiliation":[{"name":"Kazakh Eye Research Institute, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0619-3598","authenticated-orcid":false,"given":"Zhibek","family":"Dautbayeva","sequence":"additional","affiliation":[{"name":"Department of Eye Diseases, NJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","first-page":"45","article-title":"Overview of Epiphora Referred to Oculoplastic Surgery Clinic in Adults","volume":"8","author":"Ceylano","year":"2023","journal-title":"Beyoglu Eye J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"937","DOI":"10.18240\/ijo.2025.05.21","article-title":"Interventions in functional epiphora\u2013a systematic review","volume":"18","author":"Tai","year":"2025","journal-title":"Int. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.31128\/AJGP-01-24-7113","article-title":"Approach to the watery eye","volume":"53","author":"Li","year":"2024","journal-title":"Aust. J. Gen. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Jordan, D., Mawn, L., and Anderson, R.L. (2012). The Lacrimal System. Surgical Anatomy of the Ocular Adnexa, Oxford University Press.","DOI":"10.1093\/oso\/9780199744268.003.0014"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Jin, H., Chen, X., and Liu, Y. (2025). Upper eyelid predominance of meibomian gland dysfunction in postmenopausal women with primary acquired nasolacrimal duct obstruction. BMC Ophthalmol., 25.","DOI":"10.1186\/s12886-025-04439-4"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"466","DOI":"10.3897\/folmed.66.e128419","article-title":"Primary acquired nasolacrimal duct obstruction\u2014Epidemiology, clinical signs and surgical treatment","volume":"66","author":"Valcheva","year":"2024","journal-title":"Folia Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101193","DOI":"10.1016\/j.preteyeres.2023.101193","article-title":"Etiopathogenesis of primary acquired nasolacrimal duct obstruction (PANDO)","volume":"96","author":"Ali","year":"2023","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/lio2.293","article-title":"Computed Tomography Versus Dacryocystography for the Evaluation of the Nasolacrimal Duct\u2014A Study With 72 Patients","volume":"4","author":"Papathanassiou","year":"2019","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.4103\/IJO.IJO_1641_24","article-title":"The etiological spectrum of epiphora: Functional epiphora as an overlooked cause","volume":"73","author":"Cetinkaya","year":"2025","journal-title":"Indian J. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2687","DOI":"10.1007\/s10792-023-02668-4","article-title":"Functional epiphora: An under-reported entity","volume":"43","author":"Usmani","year":"2023","journal-title":"Int. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"243","DOI":"10.3341\/kjo.2016.30.4.243","article-title":"Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis","volume":"30","author":"Choi","year":"2016","journal-title":"Korean J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"39049","DOI":"10.1038\/s41598-025-24561-z","article-title":"The novel diagnostic value and characteristic imaging features of CT dacryocystography in primary lacrimal canaliculitis","volume":"15","author":"Yang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1007\/s12070-021-02447-6","article-title":"Multi-Detector CT Instillation Dacryocystography and Its Role in the Diagnosis of Lacrimal Drainage System Blocks","volume":"73","author":"Raghuwanshi","year":"2021","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_14","first-page":"e90754","article-title":"Anatomical and Functional Alterations in Nasolacrimal Duct Obstruction: A Comprehensive Review","volume":"17","year":"2025","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102026","DOI":"10.1016\/j.ajoc.2024.102026","article-title":"The role of CT-DCG in hardware\u2014Associated secondary acquired lacrimal duct obstruction: SALDO update study-(SUP)-Paper III","volume":"34","author":"Agarwal","year":"2024","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II Definition and Classification Report","volume":"15","author":"Craig","year":"2017","journal-title":"Ocul. Surf."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gupta, N. (2021). Imaging in Disorders of the Lacrimal Drainage System. Endoscopic Dacryocystorhinostomy, Springer.","DOI":"10.1007\/978-981-15-8112-0_5"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1186\/s43163-025-00869-5","article-title":"Role of CT dacryocystography in the management of lacrimal drainage system obstruction","volume":"41","author":"Hamdy","year":"2025","journal-title":"Egypt. J. Otolaryngol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1740\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T09:19:29Z","timestamp":1780651169000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":18,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16111740"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16111740","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]}}}