08Infection Lacrimal

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INFECTIONS OF LACRIMAL PASSAGES 1. Congenital nasolacrimal duct obstruction 2. Congenital dacryocele 3. Chronic canaliculitis 4. Dacryocystitis Acute Chronic

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Congenital nasolacrimal duct obstruction Caused by delayed canalization near valve of Hasner On pressure reflux of purulent material from punctum Infrequently acute dacryocystitis Epiphora and matting

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Treatment of congenital nasolacrimal duct obstruction Massage of nasolacrimal duct and antibiotic drops 4 times daily Improvement by age 12 months in 95% of cases If no improvement - probe at 12-18 months Results - 90% cure by first probing and 6% by second

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Congenital dacryocele Bluish cystic swelling at or below medial canthus May become secondarily infected Do not mistake for encephalocele - pulsatile swelling above medial canthal tendon Distension of lacrimal sac by trapped amniotic fluid (amniontocele) caused by imperforate valve of Hasner Initially massage Probing if massage fails Treatment

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Oedema of canaliculus and pouting punctum Treatment - simple curettage or canaliculotomy Frequently caused by Actinomyces ( Streptothrix sp.) Unilateral epiphora and chronic mucopurulent discharge Chronic canaliculitis Expressed concretions consisting of sulphur granules

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Acute dacryocystitis May develop into abscess Systemic antibiotics and warm compresses DCR after acute infection is controlled Usually secondary to nasolacrimal duct obstruction Tender canthal swelling Mild preseptal cellulitis Treatment

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Chronic dacryocystitis Epiphora and chronic or recurrent unilateral conjunctivitis Expressed mucopurulent material Painless swelling at inner canthus Treatment - DCR

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Dacryocystorhinostomy

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