CHRONIC DACRYOCYSTITIS Dr Maj G Premnath Dept of

CHRONIC DACRYOCYSTITIS Dr. (Maj) G. Premnath Dept of Ophthalmology

ANATOMY- Lacrimal apparatus

LACRIMAL DRAINAGE SYSTEM 1. Puncta located at post edge of lid margin medially. 2. Canaliculi has 2 parts, vertical ampullae(2 mm) and horizontal part(8 mm). 3. Supr and infr canaliculi unite to form common canaliculi and open into lat wall of lacrimal sac.

Lacrimal sac(10 mm), lies in the lacrimal fossa between ant and post lacrimal crest. Nasolacrimal duct (12 mm) - continuation of lacrimal sac that descends slightly laterally and posteriorly and opens into nasal inferior meatus

CLASSIFICATION OF DACRYOCYSTITIS TYPES ACQUIRED ACUTE CONGENITAL CHRONIC

CHRONIC DACRYOCYSTITIS ØPredisposing Factors ØFactors causing stasis of tears ØSource of infection ØCausative organisms

1. Predisposing factors • Age • Sex • Race • Heredity • Socio-economic status • Poor personal hygiene

2. Factors causing stasis of tears • Anatomical factors • Foreign bodies • Excessive lacrimation • Mild grade inflammation • Obstruction of lower end of NLD

3. Source of infection

4. Causative organisms • Most common – Staphylococci, Pneumococci, Streptococci, Pseudomonas pyocyanea

STAGES 1. Stage of chronic catarrhal dacryocystitis 2. Stage of lacrimal mucocoele 3. Stage of chronic suppurative dacryocystitis 4. Stage of chronic fibrotic sac

1. Stage of chronic catarrhal dacryocystitis • Symptoms • Lacrimal syringing – clear fluid or few fibrinous flakes • Dacryocystography – block in the NLD, normal sized lacrimal sac with healthy mucosa

2. Stage of lacrimal mucocoele • Symptoms • Dacryocystography – distended sac with blockage in the NLD • Regurgitation test – milky or gelatinous fluid • Encysted mucocoele

3. Stage of chronic suppurative dacryocystitis • Symptoms • Regurgitation test – frank mucopurulent discharge • Encysted pyocoele 4. Stage of chronic fibrotic sac • Symptoms • Dacryocystography – very small sac with irregular mucosal folds

COMPLICATIONS • Chronic intractable conjunctivitis • Ectropion of lower lid, maceration and eczema of lower lid skin • Hypopyon corneal ulcer • Operative complications - endophthalmitis

TREATMENT • Dacryocystorhinostomy (DCR) • Dacryocystectomy (DCT) – only when DCR is contraindicated

Lacrimal Surgery. 1. Conventional DCR Indicated for obstruction beyond opening of common canaliculus. Principle – Anastomosis of the lacrimal sac to the nasal mucosa of middle nasal meatus. 2. Lester Jones Tube Indicated when there is canalicular obstruction < 8 mm from the puncta or in lacrimal pump failure.

3. Endoscopic Surgery 4. Endolaser DCR (Using Holmium: YAG or KTP Laser) 5. Balloon Dacryoplasty

Endo nasal DCR �Intra nasal approach �No Scar �Young people �Quick Recovery �Success rate 85 % �Revision of failed external DCR. �Small learning curve.

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