Tearing: hyperlacrimation, epiphora

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Tearing hyperlacrimation, epiphora
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Dry eye tear break-up time, Schirmer
test
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Epiphora-malpositioning-obst.

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INFECTIONS OF LACRIMAL PASSAGES
1. Congenital nasolacrimal duct(NLD)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,Common
• On pressure reflux of purulent material from
  punctum

Epiphora and matting
Infrequently acute dacryocystitis
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Treatment of congenital nasolacrimal duct
obstruction

• one third bilateral
• Role out congenital glaucoma
• Massage of nasolacrimal duct10strokes 4 times a
  day
• antibiotic drops 4 times daily if..discharge
• Improvement by age 12 months in 95 of cases

• If no improvement - probe at 12 months
• Results - 90 cure by first probing
• 6 by repeated probing

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Congenital dacryocele
Distension of lacrimal sac by trapped amniotic
fluid (amniontocele) caused by imperforate valve
of Hasner

• Bluish cystic swelling at or below medial
  canthal
• tendon
• May become secondarily infected
• Do not mistake for encephalocele
• - pulsatile swelling above medial canthal
  tendon

Treatment

• Initially massage
• Probing if massage fails

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Acute dacryocystitis
Usually secondary to nasolacrimal duct
obstruction and tear stasis

• May develop into abscess
• Intraosseous obstruction

• Tender canthal swelling
• Mild preseptal cellulitis

Treatment

• Systemic antibiotics and warm compresses
• DCR after acute infection is controlled

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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