Congenital NLD obstruction (Infantile dacryocystitis)

Etiology: Imperforate hasener’s valve (Most common).
Symptoms: Epiphora, 2-3 weeks after birth, is reported by the mother.
Signs
1. Regurgitation test clear fluid, mucous or frank pus.
2. Recurrent conjunctivitis.
Treatment
1. Hydrostatic massage: Instruct the mother to press on the lacrimal sac in a downwards direction. This may help removing any epithelial remnants & opening hasener’s valve.
2. Antibiotics.
3. Probing: Of great success rate.
4. Repeated syringing & irrigation.
5. Intubation of the lacrimal drainage system (Silicone tube).
6. Dacryocystorhinostomy (DCR).VGZGQ6DMSXZD

Acute dacryocystitis

Definition: Acute suppurative inflammation of the lacrimal sac.

Etiology
Predisposing factors:
• Nasolacrimal duct obstruction   • Chronic dacryocystitis.
Causative agent:
• Pneumococci
• Staphylococci
• Streptococci.
Symptoms
1. Severe pain.
2. Fever.
3. Epiphora.
Signs
1. Tender swelling of the lacrimal sac.
2. Marked edema & redness of the skin over the sac.
3. Regurgitation test: Reflux of pus, unless pericystitis occurs.
4. Abscess formation with fluctuation.
Complications
1. Lacrimal fistula: Anterior bursting of the sac through the skin.
2. Pyocele: Obstruction of the canaliculi ===> distension of the sac with pus.
3. Orbital cellulites: Ending in optic nerve atrophy  blindness.
4. Cavernous sinus thrombosis (CST).
5. Chronic dacryocystitis.
Treatment
1. During the acute phase:
• Systemic & topical antibiotics.
• Hot fomentations.
• Lotions: To clear pus.
• Incision & drainage: If an abscess forms.
2. After subsidence of the acute attack:
Dacryocystorhinostomy (DCR) with or without fistulectomy.