08 infection lacrimal

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

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  • INFECTIONS OF LACRIMAL PASSAGES1. Congenital nasolacrimal duct obstruction2. Congenital dacryocele3. Chronic canaliculitis4. Dacryocystitis Acute Chronic

  • 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

  • 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

  • Congenital dacryocele Bluish cystic swelling at or below medial canthus

    May become secondarily infected

    Do not mistake for encephalocele

    - pulsatile swelling above medial canthal tendonDistension of lacrimal sac by trapped amniotic fluid (amniontocele)caused by imperforate valve of Hasner Initially massage

    Probing if massage fails

    Treatment

  • Oedema of canaliculus and pouting punctumTreatment - simple curettage or canaliculotomy Frequently caused by Actinomyces (Streptothrix sp.) Unilateral epiphora and chronic mucopurulent discharge

    Chronic canaliculitis Expressed concretions consisting ofsulphur granules

  • 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

  • Chronic dacryocystitisEpiphora and chronic or recurrent unilateral conjunctivitisExpressed mucopurulent material Painless swelling at inner canthusTreatment - DCR

  • DacryocystorhinostomySuturing of anterior flaps