This document discusses watering eye (epiphora) and its causes including hyperlacrimation and obstruction of tear outflow. It describes various mechanical obstructions that can cause epiphora such as punctal, canalicular, lacrimal sac or nasolacrimal duct obstructions. Clinical evaluation methods are outlined. Dacryocystitis, an infection of the lacrimal sac, is discussed including its congenital and acquired forms. Congenital dacryocystitis presents in newborns with epiphora, positive regurgitation test and swelling. Acquired dacryocystitis can be chronic or acute, with chronic forms including catarrhal dacryocystitis, lacrimal

1. Dr. SOMESH.K.N

3. watering eye is characterised by
overflow of tears from conjunctival
sac.
Watering eye is mainly due to
hyperlacrimation and epiphora.

5. Causes of hyperlacrimation
Primary hyperlacrimation
Reflux hyperlacrimation
Central lacrimation

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.

7. Mechanical obstruction
Punctal causes
Canaliculi
Lacrimal sac
NLD

9. Clinical evaluation
 Ocular examination with diffuse illumination
using magnifiaction.
 Regurgitation test.
 Fluorescein dye disappearance test.
 Lacrimal syringing.
 Jones dye test.
 Dacryocystography.
 Radionucleotide dacryocystography(lacrimal
scintillography).

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

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.

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.

24. Treatment
 Conservative treatment with repeated lacrimal
syringing.
 Balloon catheter dilatation(balloon dacryocystoplasty)
 DCR
 DCT
 Conjunctivo dacryocystorhinostomy

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

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