Tearing: hyperlacrimation, epiphora
Dry eye: tear break-up time,
Schirmer test
Epiphora:
-malpositioning
-obst.
INFECTIONS OF LACRIMAL PASSAGES
1. Congenital nasolacrimal duct(NLD)obstruction
2. Congenital dacryocele
3. Chronic canaliculitis
4. Dacryocystitis
• Acute
• Chronic
Congenital nasolacrimal duct obstruction
• Caused by delayed canalization near valve of Hasner,Common
• On pressure reflux of purulent material from punctum
Epiphora and matting
Infrequently acute dacryocystitis
Treatment of congenital nasolacrimal
duct obstruction
• one third: bilateral
•Role out congenital glaucoma
•Massage of nasolacrimal duct:10strokes 4 times a day
• antibiotic drops 4 times daily: if..discharge
• Improvement by age 12 months in 95% of cases
• If no improvement - probe at 12 months
• Results - 90% cure by first probing
• 6% by repeated probing
Congenital dacryocele
Distension of lacrimal sac by trapped amniotic fluid (amniontocele)
caused by imperforate valve of Hasner
• Bluish cystic swelling at or below medial canthal
tendon
• May become secondarily infected
• Do not mistake for encephalocele
- pulsatile swelling above medial canthal tendon
Treatment
• Initially massage
• Probing if massage fails
Acute dacryocystitis
Usually secondary to nasolacrimal duct obstruction and tear stasis
• Tender canthal swelling
• Mild preseptal cellulitis
May develop into abscess
•Intraosseous obstruction
Treatment
• Systemic antibiotics and warm compresses
• DCR after acute infection is controlled
•
Chronic dacryocystitis
Epiphora and chronic or recurrent unilateral conjunctivitis
Painless swelling at inner canthus
Expressed mucopurulent material
Treatment - DCR
Dacryocystorhinostomy