Chronic dacryocystitis

Definition: Chronic inflammation of the lacrimal sac secondary to
obstruction of the nasolacrimal duct. This is the commonest lacrimal sac disorder.
Etiology
Predisposing factors:
• Nasolacrimal duct obstruction. • Acute dacryocystitis.
Causative agent:
• Pneumococci: 80% of cases.
• Staph, Strept, Trachoma & Fungi.
• TB & Syphilis: Rare.
Symptoms
1. Watery eye. 2. Discharge.
Signs
1. Red & hyperaemic inner canthus.
2. Swelling of the lacrimal sac: Below the medial palpebral ligament.
3. +ve regurgitation test: Regurgitation of mucous or pus. It becomes -ve on formation of a mucocele.
Complications
1. Chronic conjunctivitis.
2. Vicious circle of epiphora, eczema & ectropion.
3. Hypopyon ulcer.
4. Endophthalmitis: Following an intraocular operation.
5. Mucocele & pyocele: If the canaliculi are obstructed.
6. Acute dacryocystitis, abscess & lacrimal fistula.
Investigations: The same as epiphora.
Treatment
Aim:
1. Restore communication between the lacrimal sac & the nose.
2. Treatment of infection.
Lines:
1. Treatment of the cause of obstruction.
2. Dacryocystorhinostomy:
Principle: Connecting the lacrimal sac to the nasal mucosa bypassing the obstructed NLD.
Indications:
• Chronic dacryocystitis.
• Mucocele of the lacrimal sac.
• Lacrimal fistula (+ fistulectomy).
Contraindications:
• Extensive adhesions & neglected cases.
• Nasal pathology e.g. atrophic rhinitis.
• T.B. & lacrimal sac tumours.
• Hypopyon ulcer.
3. Dacryocystectomy:
Principle: Removal of the lacrimal sac.
Indications: Neglected cases, when DCR is contraindicated.