Dacrocystitis is an infection of the lacrimal sac caused by obstruction of the nasolacrimal duct. It can be acute or chronic. The document discusses the anatomy, risk factors, etiology, clinical tests including syringing and imaging like DCG to diagnose dacrocystitis. Management of acute dacrocystitis involves antibiotics, heat, and sometimes drainage of abscess. Chronic dacrocystitis has stages from catarrhal to suppurative. Surgical options like dacryocystorhinostomy are discussed to treat dacrocystitis.

1. Dacrocystitis: Diagnosis
and Management
Presented By: Dr Sahil Thakur
Moderated By: Dr Amit Raj

2. Introduction • Dacryocystitis is commonly encountered by an ophthalmologist
accounting for 87% of epiphora, which causes social embarrassment
due to chronic watering from eyes.
• It commonly affects females over 40 years of age with peak incidence
in 60 to 70 years.
• It has higher incidence among people of lower socioeconomic status.
• The prevalence of chronic dacryocystitis in cataract population has
been reported as 6.6%. It has also been reported as an important
cause of endophthalmitis thus it is imperative to evaluate the patient
for this condition before surgery.
Thomas R, Thomas S, Braganza A, Muliyil J. Evaluation of the
role of syringing prior to cataract surgery. Indian J
Ophthalmol 1997;45:211-4
Mal R, Banerjee AR, Biswas MC, Mondal A, Kundu PK,
Sasmal NK. Clinico bacteriological study of chronic
dacryocystitis in adults.J Indian Med Assoc. 2008.

3. SchematicsofSeminar
• Anatomy
• Dacrocystitis: Definition/ Types
• Risk Factors
• Etiology
• Clinical Tests
• Imaging
• Management Outline for Acute/Chronic Dacrocystitis
• Surgical Options
• Recent Advances
• Conclusion

4. Anatomy

5. Dacrocystitis:Definition • Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction
of the nasolacrimal duct at the junction of lacrimal sac.
• The term derives from the Greek dákryon (tear), cysta (sac), and -itis
(inflammation).
• Signs and symptoms may differ according to the etiology of the clinical
picture.
• Under normal conditions, the mucosa of the lacrimal sac is highly resistant
to infection. However, infections of the tear duct may develop, triggered by
functional problems.
• Although there are several causes, the main mechanism for the occurrence
of dacryocystitis is distal obstruction of the nasolacrimal duct, which leads
to the retention of tears and detritus at the bottom of the conjunctival sac
at the level of the lacrimal sac.
• A “critical mass” of bacteria may be reached, overwhelming the anti-
infection response of the lacrimal sac mucosa, leading to an acute or
chronic infection.

6. Dacrocystitis:Classification
Dacrocystitis
Acquired Congenital
Acute Chronic Acute on Chronic

7. AcuteDacrocystitis • Acute dacryocystitis consists of inflammation of the lacrimal sac, in
general caused by infection. This pathology is predominantly found in
adult women, while it is also relatively common in young infants.
• The most notable common signs and symptoms are reddening, oedema
and the presence of a painful area of induration overlying the
nasolacrimal sac, specifically just below the anatomical boundary of the
medial canthal ligament.
• Epiphora and discharge may also be observed. In particular, when
pressure is applied to the inflamed tear duct, purulent material may be
expressed through the lacrimal punctum.
• Frequently, patients may present conjunctivitis and preseptal cellulitis.
Rarely, the infection extends beyond the septum, and causes orbital
cellulitis.

8. ChronicDacrocystitis • This is more common than acute dacryocystitis and there are several
stages of presentation:
Catarrhal: there is intermittent conjunctival hyperaemia and
epiphora, with mucoid discharge that is normally sterile.
Lacrimal sac mucocele: stagnant tears collect and there is dilation of
the lacrimal sac, with mucoid content.
Chronic suppurative: epiphora and chronic conjunctivitis are
observed, with erythema of the lacrimal sac. There is reflux of
purulent material with pressure, and microorganisms are often
isolated.

9. DacrocystitisinChildren
• Dacryocystitis is rare in children and, when it
occurs, it is almost always associated with
congenital nasolacrimal duct obstruction. It
has been reported that up to 6% of healthy
newborns have this type of obstruction but, of
these, only 2.9% develop acute dacryocystitis.
• The rate is around 60% in those with
congenital dacryocoele.
• The diagnosis is clinical and must be
differentiated from preseptal cellulitis and
mucocele, by the presence of hardening,
inflammation and/or hyperaemia at the level
of the medial canthal ligament, associated
with the presence of mucopurulent material
that drains through the lacrimal punctum and
epiphora.

10. RiskFactors
•Most common risk factor is Nasolacrimal duct
obstruction.
•Higher rates of both acute and chronic dacryocystitis
have been reported among women even 70% in some
case series.
•Upto 28.6% have associated nasal pathology like DNS,
rhinitis, inferior turbinate hypertrophy.
•Dacroliths seen in 6 to 18 % patients undergoing DCR.
These have been shown to have a relationship with
makeup/cosmetics and Candida hyphae.
Pinar-Sueiro, S., Sota, M., Lerchundi, TX. et al. Curr Infect Dis
Rep (2012) 14: 137. doi:10.1007/s11908-012-0238-8

11. Etiology
• Staphylococcus aureus and Streptococcus pneumoniae being the most
common among Gram-positive and Haemophilus influenzae, Serratia
marcescens and Pseudomonas aeruginosa among Gram-negative
bacteria.
• Anaerobic microorganisms have been isolated in as many as 15.7% of
the positive cultures, in some studies, the most common genus being
Bacteroides (5.7%).
• As for fungi, they have been reported to be present in 4% to 7% of
cases, the most commonly isolated genus being Candida, although
Aspergillus and Mucor may also be found.

12. Pinar-Sueiro, S., Sota, M., Lerchundi, TX. et al. Curr Infect Dis Rep (2012) 14: 137. doi:10.1007/s11908-012-0238-8

13. ClinicalTests To evaluate patient for dacrocystitis
we need to perform the following
tests:
1. Examination of adnexa and
puncta
2. ROPLAS
3. Snap back test/ Pinch test and
Examination of Lids
4. Fluorescein Dye Disappearance
Test
5. Tear Film Break up Time
6. Jones Dye Test
7. Syringing and Probing
8. Schirmer’s Test
ASSESS LACRIMAL DYSFUNCTION
ASSESS LACRIMAL DRAINAGE FUNCTION
AND PATENCY
ASSESS LEVEL OF OBSTRUCTION
ASSESS TEAR PRODUCTION

14. ROPLAS • Technique: The anterior lacrimal crest is identified by tracing
the inferior orbital margin medially and superiorly. The index
finger is then directed behind the crest and used to apply
pressure on the sac area in an upward and medial direction
so as to express the contents of the lacrimal sac into the
conjunctiva. Any reflux of fluid or purulent material from the
puncta is noted.
• ROPLAS has a sensitivity of 88.9% and specificity of 99.0% as
compared to syringing when used for cataract patients.
Thomas R, Thomas S, Braganza A, Muliyil J. Evaluation of the
role of syringing prior to cataract surgery. Indian J Ophthalmol
1997;45:211-4

15. FluoresceinDyeDisappearance
Test

16. Schirmer’sTest

17. SyringingTest
Syringing Pressure Syringing

19. IMAGING
The following imaging modalities are available to us
that further supplement the clinical tests:
•Dacryocystography (DCG)
•Nuclear lacrimal scintigraphy
•Computed Tomography (CT)
•Magnetic Resonance Imaging (MRI)

20. DCG • Dacryocystography is an anatomical investigation and is
indicated if there is a block on syringing in the lacrimal
system, and thus it can help in creating an image of how
the internal anatomy of the lacrimal system looks.
• Indications of DCG:
1. Complete obstructions: the size of the sac
determination of the exact location of an obstruction
(common canaliculus, sac)
2. Incomplete obstructions and intermitent tearing:
location of the stenosis; diverticuli; stones; and no
anatomical pathology (functional disorders)
3. Failed lacrimal surgery: size of the sac
4. Suspicion of sac tumors, traumatic injury to the face

21. DCG Radiological Criteria of Lacrimal Pathology:
1. Regurgitation of (radio-opaque) fluid into the conjunctival
sac (retention of fluid, absence of fluid in the nose,
fluctuation of lumen of lacrimal system)
2. Irregularity in contrast
3. Cystic dilation and aneurysm
4. Deformation and drawing of the lacrimal sac

22. NuclearLacrimalScintigraphy •Nuclear lacrimal scintigraphy is a simple, non-
invasive physiological test that evaluates patency of
the lacrimal system.
•Scintigraphy uses a radiotracer (technetium-99m
pertechnetate), which is very easily detectable with
a gamma camera.

23. CTScan •CT is required in the following situations:
1. Following trauma
2. To evaluate a patient with a suspected lacrimal sac
malignancy
3. To evaluate the infant with a medial canthal mass

24. MRIandMRDCG • Magnetic resonance imaging combined with contrast
agent offers many advantages over other imaging
studies. Here lacrimal system is not cannulated and is
not under increased hydrostatic pressure, which gives a
true functional status of nasolacrimal drainage system.
• Gadolinium is used as topical solution (1:10–1:100 in
normal saline)—one drop per minute for 5 minutes.
• MRI is reserved in cases where tumors are suspected.
ADVANTAGE

25. Management:Acute
Dacrocystitis
• In adults, the most widely recommended treatment for the
management of people with acute dacryocystitis consists of the
application of heat with massage, systemic antibiotics (oral or
intravenous administration, as appropriate) and percutaneous abscess
drainage.
• On the other hand, for cases that course with a clear abscess,
drainage by puncture and aspiration of the lacrimal sac seems to be
the technique of choice for treatment, as well as for the diagnostic
information it provides.
• Sometimes it is not possible to drain sufficient mucopurulent material
from the sac, leading to recurrent and prolonged inflammation, the
formation of lacrimal cutaneous fistulae adjacent to the medial
canthal ligament, and of fibrous and granulation tissue in the lacrimal
sac.

26. Management:Acute
Dacrocystitis
• Classically, surgical intervention has not been considered an option for
the treatment of purulent acute dacryocystitis due to the risk of
clinical worsening and spread of the infection.
• However, there is a growing interest in the role of transcanalicular
endoscopic laser-assisted dacryocystorhinostomy and nasal
endoscopic surgery for the management of this type of infection.
• This allows simultaneous diagnosis and treatment of the nasal
abnormality underlying the infection (nasal septum deviation, middle
turbinate hypertrophy, or chronic ethmoid sinusitis.
• Recent studies show that endoscopic technique can be treatment of
choice from the start, since it is more effective than conservative
treatment and achieves earlier resolution of the condition than with
external dacryocystorhinostomy (3.4±1 and 8.3±1.3 days, respectively)
Cahill KV, Burns JA. Management of acute
dacryocystitis in adults. Ophthal Plast
Reconstr Surg. 1993;9:38–41.
Wu W, et al.: Primary treatment of acute dacryocystitis
by endoscopic DCR with silicone intubation guided by a
soft probe. Ophthalmology 2009.

27. Pinar-Sueiro, S., Sota, M., Lerchundi, TX. et al. Curr Infect Dis Rep (2012) 14: 137. doi:10.1007/s11908-012-0238-8

28. AcuteDacrocystitis:Children • In the particular case of pediatric patients with acute
dacryocystitis, there is an association with a higher rate of
intranasal mucocele, preseptal cellulitis and retrobulbar
abscesses.
• Intubation of the nasolacrimal duct, hospital admission and
the use of intravenous antibiotics have been recommended.
• Given this risk, of systemic spread in up to 17.5% of patients
who undergo intubation prior administration of systemic
antibiotics 24h before surgery is recommended.
Jones LT,Wobig JL, eds.: Surgery of the eyelids and lacrimal system.
Birmingham, AL: Aesculapius Publishing Co, 1976: 185–93.
Walland MJ, Rose GE. Soft tissue infections after open lacrimal
surgery. Ophthalmology. 1994;101:608–11.

29. Pinar-Sueiro, S., Sota, M., Lerchundi, TX. et al. Curr Infect Dis Rep (2012) 14: 137. doi:10.1007/s11908-012-0238-8

30. Management:Chronic
Dacrocystitis • Management of chronic dacryocystitis varies according to the
age of patients.
• In adults, it has been proposed that patients with lacrimal
sac swelling and suspicion of obstruction of the lacrimal
drainage system associated with tear stones should be
treated conservatively; using lacrimal sac massage and
lacrimal irrigation until symptoms improve, reserving surgery
for cases refractory to these techniques.
• If surgery is planned, studies recommend the use of
prophylactic antibiotics for dacryocystorhinostomy especially
in patients who have had prior episodes of mucocele,
mucopyocele, or acute dacryocystitis.

31. ChronicDacrocystitis:Pediatric
Patient • If clinical signs are suggestive of congenital nasolacrimal duct
obstruction, being the patient less than 12 months of age,
conservative treatment is recommended as more than 90% of
these patients experience spontaneous resolution.
• Early surgery (nasolacrimal intubation) should be indicated if the
patient associates a dacryocele or episodes of acute dacryocystitis.
Between 12 and 18 months of age nasolacrimal probing is
recommended.
• Patients between 18 and 36 months could benefit of nasolacrimal
dilation or intubation.
• Patients older than 3 years of age, dacryocystorhinostomy is
indicated. Antibiotic prophylaxis during or after surgery is not
essential, unless the patient has mucopurulent collection in
conjunctival sac after expression of the lacrimal sac.

32. Pinar-Sueiro, S., Sota, M., Lerchundi, TX. et al. Curr Infect Dis Rep (2012) 14: 137. doi:10.1007/s11908-012-0238-8

33. There are four markings at
10 mm intervals.
• When the first mark at 10 mm
approaches the punctum, tip of
the probe enters the lacrimal sac.
• As 20 mm approaches the
punctum, tip of the probe is at the
level of the upper end of the
nasolacrimal opening.
• As 30 mm approaches the
punctum, tip of the probe is at
valve of Hasner.
• Beyond 30 mm probe is in the
nasal cavity, in the inferior meatus.
• At 40 mm tip of the probe is on
the floor of the nose, which gives
an indication to stop further
probing.
• Probing was first practiced by Anel in 1713 and popularized by
Bowman in 1857.
• Probing is indicated between 6 months and 13 months of age.
Probing

34. WhatifProbingFails?
Takahashi, Y., Kakizaki, H., Chan, W. O. and Selva, D. (2010), Management of congenital nasolacrimal duct
obstruction. Acta Ophthalmologica, 88: 506–513.

35. SiliconTubeIntubation
Takahashi, Y., Kakizaki, H., Chan, W. O. and Selva, D. (2010), Management of congenital nasolacrimal duct
obstruction. Acta Ophthalmologica, 88: 506–513.

36. SurgicalOptions
•DCR
External
Endonasal
•Conjunctivodacryocystorhinostomy (CDCR)
•Minimal Invasive Lacrimal Surgery
Balloon Dacroplasty
9mm Balloon assisted DCR

37. •Dacryocystorhinostomy (DCR) introduced by Toti
in 1904 is a lacrimal drainage operation in which a
fistula is created between the lacrimal sac and the
nasal cavity in order to bypass an obstruction in
the nasolacrimal duct.
•The procedure can be performed via an external
skin incision (external DCR) or through the nose
(endoscopic DCR), either under local anesthesia,
with or without intravenous sedation, or under
general anesthesia.
DCR

38. ExternalDCR • Indications
1. Chronic epiphora due to a nasolacrimal duct
obstruction
2. Recurrent or chronic dacryocystitis
3. Failed probings and silicone intubations in a
child
4. Proposed intraocular surgery in the
presence of nasolacrimal duct obstruction
• Contraindications
1. Acute dacryocystitis
2. Malignant lacrimal sac tumor

39. ExternalDCR Surgical Procedure
The operation consists of four parts:
1. Skin incision, retraction of the wound, and
exposure of the lacrimal fossa
2. The osteotomy
3. The mucosal flaps and stent placement
4. The wound closure

40. ExternalDCR:Incision

41. ExternalDCR:Landmarks

42. ExternalDCR:Osteotomy

43. ExternalDCR:Osteotomy
Extent of osteotomy should be as follows:
Posteriorly: Till lamina papyracea.
Superiorly: At or slightly above level of MPL.
Anteriorly and Inferiorly: As much as possible

44. ExternalDCR:Lacrimaland
NasalMucosaFlaps

45. ExternalDCR:FlapClosure

46. ExternalDCR:Modifications Modifications in DCR:
1) Single flap: There seems to be no difference in outcome of
the surgery if the posterior flaps are excised and only the
anterior flaps are sutured.
2) Mitomycin C: Use of Mitomycin C, an anti-proliferative agent
in a concentration of 0.2 to 0.4 mg/ml of has been reported
increase the success rate of DCR to around 95%.The technique
involves placing a sponge soaked in Mitomycin C over the
anastomosed posterior flaps and osteotomy site for 30 minutes.
Serin D,et al. External Dacryocystorhinostomy: Double-Flap Anastomosis or Excision of the
Posterior Flaps. Ophthal Plastic and Reconst Surg; 23(1) 28–31.
Liao SL, Kao SCS, Tseng JHS, Chen MS, Hou PK. Results of intraoperative mitomycin C
application in dacryocystorhinostomy. Br J Ophthalmol 2000;84:903–906.

47. ExternalDCR:Modifications 3) Silicone tube intubation: Bicanalicular silicone tube
intubation is useful in cases with associated canalicular
stenosis, post traumatic nasolacrimal duct obstruction and
treating previously failed DCR. The use of silicone intubation
along with DCR has reportedly increased the success rate to
95%. Kashkouli MB, Parvaresh MM, Modarreszadeh M, Hashemi M, Beigi B.
Factors affecting the success of external dacryocystorhinostomy. Orbit
2015; 22(4): 247-55.

48. ExternalDCR:Modifications 4) Fistulectomy: In cases of fistula formation additional
fistulectomy is required with DCR. Sometimes infected lacrimal
sac along with necrotic tissue is to be extensively removed and
such cases require lacrimal intubation along with DCR to make
sure that the newer tract remains patent. Systemic antibiotics
are essential to prevent relapse.

49. ExternalDCR:Complications
Early complications include wound dehiscence,
wound infection, tube displacement, excessive
rhinostomy crusting and intranasal synechiae.

50. ExternalDCR:Complications Intermediate complications include granulomas at the
rhinostomy site, tube displacements, intranasal synechiae,
punctal cheese-wiring, prominent facial scar and
nonfunctional DCR.

51. ExternalDCR:Complications Late complications include rhinostomy
fibrosis, webbed facial scar, medial
canthal distortion, and failed DCR.
1. Fistula formation
2. Lacrimal abscess
3. Orbital cellulitis
4. Meningitis
5. Cavernous sinus thrombosis
RARESEQUELAE

52. EndonasalDCR
The operation consists of four parts:
1. The fashioning of a nasal mucosal flap
2. The osteotomy
3. The opening of the lacrimal sac and the
creation of anterior and posterior flaps
4. The manipulation and replacement of the
nasal mucosal flap and placement of the
silicone stent

53. EndonasalDCR:MucosalFlap

54. EndonasalDCR:Osteotomy

55. EndonasalDCR:Osteotomy

56. EndonasalDCR:LacrimalFlap

57. EndonasalDCR:Intubation

58. EndonasalDCR

59. EndonasalDCR:PostOpCare
• Irrigation of the nose at least twice a day to remove dried
clots and debris for a minimum period of 2 weeks
postoperatively.
• Steroid nasal spray and a decongestant nasal spray nasal are
prescribed for 5 days.
• Gentle syringing of the lacrimal drainage system is
undertaken 1 week following the surgery.
• Endoscopic examination to remove excessive intranasal
debris.
• Stent removed in clinic endoscopically 6 to 8 weeks
postoperatively.
• Topical or systemic antibiotics are only used in patients who
have had previous dacryocystitis or who are diabetic or
immuno- compromised.

60. LaserassistedEndonasalDCR • In an attempt to achieve precise bone removal with
meticulous hemostasis, the laser DCR was developed and
first described by Massaro et al in 1990.
• The Ho:YAG laser fibers have multiple use specification and
this can potentially reduce the cost per procedure. The
major disadvantage is the splattering of tissue with soiling of
the lens, requiring frequent cleaning and more collateral
damage when compared with the KTP laser.
• The KTP/532 with its star-pulse mode is most suitable as it
vaporizes the bone effortlessly and without splattering. The
major disadvantage of the KTP is that the optical fiber is
marketed for single use and therefore the cost per procedure
for these lasers is significantly higher.

61. LaserassistedEndonasalDCR • Literature reports success rates for the various
lasers of around 60–80%.
• Conventional DCR has better surgical outcome
than Endonasal DCR with laser because of a
wider bony opening and it obviates the thermal
damage caused by the laser which produces
more fibrosis and occlusion at the rhinostomy
site.
Weber, et al. Atlas of Lacrimal
Surgery, Springer, 2009.

62. EndonasalDCR:Advantages
1. Short operating time (30 to 45 min)
2. Minimal postoperative morbidity
3. Minimal disruption of adjacent structures
4. No cutaneous scarring
5. High patient acceptance
6. Easy revision surgery
7. Ideal for the patient with a bleeding diathesis
or who is using anti-coagulants
8. Nasal pathology can be treated simultaneously

63. •Conjunctivodacryocystorhinostomy (CDCR) is
the creation of a passage for drainage of
tears from the conjunctival culde-sac, at the
medial canthus, to the middle meatus of the
nose.
•To maintain the patency, a pyrex glass or
other tube is inserted in the fistula.
•The procedure was first described by Lester
Jones in 1965, and the standard glass tubes
are named Jones tubes.
Conjunctivodacryocystorhinostomy
(CDCR)

64. Conjunctivodacryocystorhinostomy
(CDCR)

65. Conjunctivodacryocystorhinostomy
(CDCR)

66. •Literature reports over 90% of patients free of
symptoms of watering after insertion of the Jones
tube.
•Tube extrusion, malposition or migration is the
most common complication after surgery. The
rate may be as high as 50% or more of the
patients.
•The high rate of complications, maintenance, and
secondary procedures required may cause
dissatisfaction even in patients with a successful
functioning CDCR.
Conjunctivodacryocystorhinostomy
(CDCR)
Zilelioglu G, Gündüz K.Conjunctivodacryocystorhinostomy with Jones tube. A 10-year
study. Doc Ophthalmol. 1996-1997; 92(2):97-105.

67. SmartProbe

68. BalloonDacroplasty • Balloon dacryoplasty is a term used for a set of minimally invasive
lacrimal procedures that utilizes specially designed balloons,
targeted at different points in the lacrimal system for a wide range
of indications.
• Balloons were first used by Becker and Berry in 1989.
• A 2 mm balloon is used for patients less than 30 months of age and
3 mm for children more than 30 months of age. Also available are
4mm and 5mm balloons.
• The indications of balloon dacryoplasty for CNLDOs are:
 Failed probing
 Failed intubation
 Older children (> 12 months of age)
 Down’s syndrome or any syndromic association with CNLDO.

69. BalloonDacroplasty

70. 9mmBalloonassistedDCR
• Primary endoscopic DCR using the 9 mm nasal balloon catheter is a good
alternative to an external or endoscopic DCR. It was introduced and popularized
by Silbert DI.
• The advantages of this procedure include:
 Reduced operative trauma
 Less bleeding
 Faster and less time consuming
 No need for powered endoscopic instruments
 Less postoperative morbidity
 Early rehabilitation
 High success rates.

71. • Balloon dacryoplasty for CNLDO is a very effective treatment
modality.
• The success rates range from 76% to 83% in various large
case series.
• The results of primary endoscopic 9 mm balloon DCR’s in
adults in long term are also appearing to be quite
encouraging. Silbert DI in a large case series of 97 patients
showed a success rate of 92%.
BalloonDacroplasty:Results
Silbert DI, Matta NS. Outcomes of 9 mm balloon-assisted
endoscopic dacryocystorhinostomy: retrospective review
of 97 cases. Orbit. 2010.
Yuksel D, Ceylan K, Erden O, et al. Balloon dilatation for
treatment of congenital nasolacrimal duct obstruction. Eur
J Ophthalmol. 2005.

72. EndonasalDCR:What'sNew? Combined Transcanalicular Endonasal Diode Laser Dacryocystorhinostomy
85.4% of 125 cases had complete resolution of their symptoms. The functional success rate
decreased to 67.7% at 6 months, to 63.3% at first year, and to 60.3% at second year, while the
patency of the lacrimal drainage system was restored in 93.1%, 74.6%, 69.5%, and 68.2% of the
cases, respectively.

73. CONVENTIONAL TEACHING CURRENT SCENARIO

74. TheDCRConundrum:Externalor
Endonasal
• There is an overall result favoring external DCR with a success rate
of 84% (897/1068) for END-DCR and 87% (863/993) for EXT-DCR,
but when (Endonasal with Drill) EM-DCR and (Endonasal with Laser)
EL-DCR are separately compared to EXT-DCR, the success rates of
EM-DCR are comparable to EXT-DCR (87%; 624/714), while the
results of EL-DCR (77%; 273/354) clearly favor EXT-DCR.
• The metanalysis recommends Endonasal DCR with mechanical drill
as the procedure of choice among the three.
Orbit, 2015

75. Conclusion

76. Conclusion

77. Summary
• Dacrocystitis is an important disease that an
ophthalmologist may come across often in daily
practice.
• It is direct relationship with cataract surgery
outcome and hence needs to be timely diagnosed
and managed.
• CNLDO is an important cause of dacrocystitis in
children and can be easily managed with proper
care.

78. Summary
• Silicon tube intubation can be used in cases of failed
probing.
• In adults DCR is an effective way to manage
dacrocystitis. The scale is tipping towards
endoscopic approach but external DCR is still the
gold standard.
• Newer modalities like balloon dacroplasty can be
tried in children where probing fails and adult
patients who prefer cosmesis.