6. Epiphora(DOWN POUR)
Obstruction to the outflow of
normally secreted tears.
Epiphora may be due to
physiological (lacrimal pump
failure) or anatomical(mechanical
obstruction) cause.
14. Dacryocystitis
Dacryocystitis is an infection of the lacrimal sac
secondary to obstruction of the nasolacrimal
duct at the junction of lacrimal sac.
Dacryon= tear, cyst= sac
Simply dacryocystitis is an inflammation of
lacrimal sac.
Dacryocystitis may be congenital or
acquired.
15. Congenital dacryocystitis
Inflammation of lacrimal sac occuring in new
born infants( dacryocystitis neonatorum)
Etiology
congenital blockage in NLD
Clinical picture
1.epiphora
2.positive regurgitation test
3.swelling
16.
17. Differential diagnosis
It should be differentiated from ophthalmia
neonatorum and congenital glaucoma
Complications
Recurrent conjunctivitis
Lacrimal abscess
Fistulae formation
18. Treatment
Massage over lacrimal sac area and topical
antibiotics in first month(3-4 weeks of age).
Lacrimal syringing (if not cured up to 2months
of age)
Probing of NLD with Bowmans probe(if not
cured up to 3-4months)
Balloon catheter dilatation(if probing fails)
Intubation with silicone tube(If probings and
catheter dilation fails)
DCR operation(final approach at the age of 4)
19. Acquired dacryocystitis
It may be acute or chronic
Chronic dacryocystitis:
Etiology
Etiology is of multifactorial.
Vicious cycle of stasis and mild infection of long
duration
Predisposing factors.
Factors responsible for stasis of tears in lacrimal
sac(anatomical factors,foreign body,inflammation of
lacrimal sac, obstruction of NLD)
20. Clinical picture
1.chronic catarrhal dacryocystitis
Only symptom is watering eye
DCG reveals block in NLD, normal sized lacrimal sac
with healthy mucosa.
2.Lacrimal mucocoele
Distension of lacrimal sac.
Characterised by constant epiphora associated with
swelling below inner canthus.
Milky or gelatinous fluid from lower punctum on
pressing swelling.
DCG reveals distended sac with blockage in NLD
21. Some times due to chronic infection, opening of both
canaliculi into sac are blocked leading to negative
regurgitation test. This is called encysted mucocele.
3.Chronic suppurative dacryocystitis
Due to pyogenic infection, the mucoid discharge becomes
purulent, converting it into pyocoele
Characterised by epiphora, associated recurrent
conjunctivitis and swelling at the inner canthus with mild
erythema of overlying skin.
On regurgitation test, frank purulent discharge flows from
lower punctum. If openings of canaliculi are blocked then
encysted pyocole.
22.
23. 4.Chronic fibrotic sac.
Low grade repeated infections for a
prolonged period ultimately result in a small
fibrotic sac due to thickening of mucosa,
which is often associated with persistant
epiphora and discharge.
DCG at this stage reveals very small sac with
irregular folds in mucosa.
25. Acute dacryocystitis
It is an acute suppurative inflammation
of lacrimal sac, characterised by
presence of a painful swelling in region
of sac.
Clinical picture
stage of cellulitis
stage of lacrimal abscess
stage of fistula formation
26.
27. Treatment
During cellulitis stage
During stage of lacrimal abscess
Treatment of external lacrimal fistula
Surgical technique of DCR:
1.Conventional external approach DCR
2.Endonasal DCR
3.Endocanalicular laser DCR