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Home > The Lacrimal System
Acute Dacryocystitis
 

Definition:-

Acute suppurative inflammation of the lacrimal sac.

Etiology:-

- It occurs almost always on top of chronic dacryocystitis (it rarely occurs without NLD obstruction).

- The causative organism may be pneumococcus, staph., strept.

Clinical picture:-

Symptoms:

1. Acute pain in relation to the area of sac:

- Dull aching pain in the diffuse stage.

- Throbbing pain in the localized stage.

2. Red, hot and tender swelling below the medial canthus.

3. Fever, headache and malaise.

4. Watering of the eye.

Signs:

1. Epiphora.

2. Swelling:-

a. In the diffuse stage there is diffuse hyperemia and edema with maximal tenderness below the medial palpebral ligament.

b. In the localized stage there is a localized swelling below MPL.

c. Lacrimal abscess formation where pus points below MPL.

3. Negative regurge test because the canaliculi are closed by edema (functional obstruction).

4. Submaxillary lymphadenitis.

Complications:-

1. Local complications:

- Lacrimal fistula if lacrimal abscess opens through the skin.

- Pyocele.

- Orbital cellulitis.

2. Cavernous sinus thrombosis (the most dangerous complication).

Treatment:-

1. Control inflammation by local and systemic antibiotics, hot fomentation and analgesics.

2. If pus is pointing we incise and drain it because the surgical incision has a chance of fistula formation less than spontaneous rupture.

3. DCR operation is absolutely contraindicated in the acute phase of inflammation. It is done after complete resolution of the acute condition in order to treat the underlying chronic dacryocystitis.

 

LACRIMAL FISTULA

Definition:-

An abnormal canal of infected granulation tissue connecting the cavity of the sac to the skin.

Etiology:-

Acute dacryocystitis ---> lacrimal abscess ---> opens through skin.

Clinical picture:-

Symptoms:

- Watering of the eye.

- History of acute dacryocystitis.

Signs:

The small opening of the fistula is seen below the medial palpebral ligament. Pressure on the sac causes flux of discharge from the fistula.

Investigations:

1. Irrigation with saline: it will go out of the fistula.

2. Dacryocystography: the cause of NLD obstruction will be identified.

3. ENT examination (as before).

4. Culture and sensitivity test.

Treatment:-

DCR + fistulectomy: The fistula is removed by and elliptical incision during DCR.

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