Narrowing or occlusion of the tear dots
Caused by scarring adhesions due to trauma or inflammation
Treatment.
Stricture-dilation by tear duct dilator.
Occlusion-probe for access or surgery.
Lacrimal duct obstruction
Etiology: inflammation, trauma, congenital malformation.
Examination: lacrimal duct flushing, see reflux of flushing fluid in situ.
Treatment: lacrimal duct probing with poor results.
Tear duct placement.
Nd:YAG or KTP lacrimal laser.
Conjunctival lacrimal sac anastomosis or conjunctival lacrimal sac nasal anastomosis.
Nasolacrimal duct obstruction
Etiology: inflammation, trauma, tumor compression, congenital malformation.
Examination: lacrimal duct flushing, see flushing fluid reflux from upper and lower tear dots.
Treatment: lacrimal duct probing with poor results.
Tear duct placement.
Nd:YAG or KTP lacrimal laser.
lacrimal sac nasal anastomosis with good results.
Chronic dacryocystitis
Definition: chronic inflammation of the lacrimal sac caused by narrowing or obstruction of the nasolacrimal duct and retention of tears in the lacrimal sac with bacterial infection.
Etiology: common causative agents: Streptococcus pneumoniae, Staphylococcus
Classification : There are 3 types: catarrhal, mucinous and purulent.
Diagnosis : tear overflow, skin eczema in the inner canthus; squeeze the tear sac area and discharge mucous and purulent secretions in the tear ducts. Tear duct flushing: flushing fluid from the upper and lower tear dots.
Treatment.
Topical antibiotics
lacrimal duct exploratory surgery
Laser lacrimal ductoplasty
Lacrimal sac nasal anastomosis (preferred) or surgery under nasal endoscopy
Lacrimal sac removal
Hazards :.
Potential foci of infection in the eye, susceptible to endophthalmitis after trauma or internal eye surgery, must be treated preoperatively.
Acute dacryocystitis
Etiology.
Chronic underlying + invasion of strong virulent germs/resistance
Common causative agents: Pneumococcus
Staphylococcus aureus
Streptococcus haemolyticus
Haemophilus influenzae (children)
Diagnosis.
Localized pain, redness and swelling
Congestion, tearing, purulent discharge from affected eye
Submandibular lymph nodes are painful and enlarged
Pus rupture of the tear sac
systemic symptoms
Treatment.
Antibiotics (topical + systemic)
Local hot compresses
Incision and drainage