11 April 2011

Chronic Dacryocystitis

Definition: A chronic inflammation of the lacrimal sac secondary to obstruction of the nasolacrimal canal. This is disorder of lacrimal sac more common.EtiologyPredisposing factors: • the canal nasolacrimal. • acute Dacryocystitis.Causal agent: • pneumococcal: 80% of cases. • Staphylococcus, streptococcal, trachoma, and fungi. • TB and Syphilis: Rare.Symptoms1. Eyes larmoyants.2. Discharge.Signs1. Canthus.2 Interior red and congested. The lacrimal sac swelling: below the median palpebral ligament.3. + regurgitation ve test: regurgitation of mucus or pus. It becomes - ve on the formation of a Mucocele. Complications1. Chronic conjunctivitis.2. Vicious circle of eczema, epiphora, and ectropion.3. Hypopyon ulcer.4. Endophthalmitis: Suite to intra-ocular operation.5. Mucocele & pyocele: If the canaliculi are obstructed.6. Acute dacryocystitis, abscess & lacrimal fistula.Investigations: clinical assessment and investigation of epiphora1. History: Exclude watery.Bilateral watering of the eye is usually due to tearing, while unilateral watering is usually due to epiphora.2. Review: • eyelids: exclude trichiasis, ectropion & blepharitis. lacrimal sac •: swelling & Dacryocystitis. • nose: polyps & deviated nasal septum.3. Investigations: 1 Test of regurgitation: Positive in the case of the NLD obstruction.2. Jones test.3. Dacryocystography.4. x-ray: diagnosis of tumors and fractures.5. For TB.6 tuberculin test. Probe diagnostic and scintillography.1. Test of regurgitation: press the lacrimal sac against the lacrimal bone: • + ve regurge: Reflux of pus or the tears of the NLD puncti. • - ye regurge: no reflux of lacrimal passages.2 patent. Test of Jones: I. Type i: inculcate fluorescin Adrop in the conjunctival sac and insert a coil of soymeal soaked in xylocaine (reflex Usneezing) under the nasal inferior turbinate. • results: 1. cotton is coloured with fluorescin passages.2 lacrimal patent. Not coloured: proceed to test type Jones II.II. Type II: After type, irrigate the lacrimal passage with a saline solution. • results: 1. If fluorescin is recovered: there is a functional of the passages.2 or partial obstruction. If fluorescin is not recovered: there is complete obstruction.3. Dacryocystography: useful for the detection of the following: tumours and calculations appearing as filling defects. Time required to fill and empty the sac.4. X-ray: To detect tumors and fractures.TreatmentAim: 1. Re-establish communication between the lacrimal sac and the nose.2. Treatment of infection.Lines: 1. treatment of the cause of obstruction. 2. Dacryocystorhinostomy: principle: linking the lacrimal sac to the nasal Mucosa, bypassing the blocked NLD.Indications: • chronic Dacryocystitis. • Mucocele of lacrimal sac. lacrimal fistula • (+ fistulectomy).Contraindications: • wide memberships & cases neglected. • nasal pathology e.g. atrophic rhinitis. • T.B. & lacrimal sac tumors. • ulcer.3 hypopyon. Dacryocystectomy: principle: deletion of the lacrimal sac.Indications: The case is neglected, when DCR is contraindicated.Obstruction of congenital NLD (infant Dacryocystitis) etiology: the hasener imperforés (more common) valve.Symptoms: Epiphora, 2-3 weeks after birth, is reported by the mother.Signs1. Regurgitation of clear test fluid, mucous membranes, or frank pus.2. Recurrent conjunctivitis.Treatment1. Hydrostatic massage: give the mother to the press on the lacrimal sac in the down direction. This can help remove the epithelial remnants and opening valve.2 of the hasener. Antibiotics.3: Probing rate.4 great success. Syringing repeated and irrigation.5. Intubation of lacrimal drainage system (Silicone tube). 6 Dacryocystorhinostomy (DCR).