Presentation on Acute Dacryocystitis.

1. Acute Dacryocystitis
AZAN RID
ROLL NO. : 100

2. Anatomy of Lacrimal System
 Lacrimal system consist of ;
1. Secretory System: Secretes tears.
 Main Lacrimal Gland
 Accessory Lacrimal Glands
2. Excretory System: Drains tear.
• Lacrimal puncta
• Lacrimal canaliculi
• Lacrimal sac
• Nasolacrimal duct

3. Lacrimal Glands
 Main Lacrimal Gland:
• These are the serous glands situated at
the upper and outer angle of orbit, in a
depression in frontal bone known as
‘fossa for the lacrimal gland’.
• Each gland is approximately the size and
shape of an almond.
• Main lacrimal gland have a superior or
orbital lobe and inferior or palpebral
lobe.

4.  Accessory Gland
• Gland of Krause: They are about
20 in number in upper lid and
about 8 in lower lid situated within
the stroma of the conjunctiva
mainly near the fornix.
• Glands of Wolfring: These are few
number situated near the upper
border of tarsal plate.

6. Secretory System
 Lacrimal puncta
 Lacrimal canaliculi
 Lacrimal sac
 Nasolacrimal duct

8. Acute Dacryocystitis
 It is the acute inflammation of
lacrimal sac.
 It is characterized by presence of
painful swelling in the region of
sac.
 Swelling in dacryocystitis is below
the medial canthal tendon.
Lacrimal sac tumor (rare) is
suspected if mass is above the
medial canthal tendon.

9. Aetiology
 De novo.
 Almost always related to nasolacrimal duct
obstruction.
 Gram- positive bacteria are the most common
pathogens; however, gram- negative and atypical
organism are seen more commonly in diabetics,
immunocompromised, and nursing home patients.

10. Clinical Features
Symptoms
 Subacute onset of painful
redness.
 Swelling at the medial canthus
associated with epiphora.
 Tearing, discharge or fever.

11. On Examination
 Swelling at medial canthus, which is reddish and
tender on touch.
 Regurgitation test is difficult to perform because of
tenderness.
 Mucopurulent or purulent discharge may be present
on the side of medial canthus.
 Abscess formation may occur in untreated cases.
 Abscess may rupture and pus comes out.

12. Complications
• Corneal ulcer, osteomyelitis of the lacrimal bone
and orbital and facial cellulitis may develop as
complications of acute dacryocystitis.
• External fistula formation.

13. Treatment
Conservative
 Hot compresses, systemic broad spectrum antibiotics, analgesics and
anti-inflammatory drugs are effective.
Surgical
 In case of lacrimal abscess, a vertical incision is given over the sac area
in the lower part to facilitate the drainage by gravity.
 In case of lacrimal fistula, excision of fistulous tract and removal of sac
is done.
 Dacryocystorhinostomy (DCR) operation is performed when acute
inflammation has settled, and there is persistent epiphora.
 In DCR an anastomosis is created between the sac and the nasal
mucosa to bypass an obstruction in the nasolacrimal duct.