Tearing: hyperlacrimation, epiphoraTearing: hyperlacrimation, epiphora

Dry eye: tear break-up time, Dry eye: tear break-up time, Schirmer testSchirmer test

Epiphora:Epiphora:-malpositioning-malpositioning-obst. -obst.

INFECTIONS OF LACRIMAL PASSAGES

1. Congenital nasolacrimal duct(NLD)obstruction

2. Congenital dacryocele

3. Chronic canaliculitis

4. Dacryocystitis• Acute• Chronic

Congenital nasolacrimal duct obstruction• Caused by delayed canalization near valve of Hasner,Common• On pressure reflux of purulent material from punctum

Infrequently acute dacryocystitis Epiphora and matting

Treatment of congenital nasolacrimal duct obstruction

• one third: bilateral•Role out congenital glaucoma•Massage of nasolacrimal duct:10strokes 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

Congenital dacryocele

• Bluish cystic swelling at or below medial canthaltendon• 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

Acute dacryocystitis

• May develop into abscess•Intraosseous obstruction

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

Usually secondary to nasolacrimal duct obstruction and tear stasis

• Tender canthal swelling • Mild preseptal cellulitis

Treatment

Chronic dacryocystitisEpiphora and chronic or recurrent unilateral conjunctivitis

Expressed mucopurulent material Painless swelling at inner canthus

Treatment - DCR

Dacryocystorhinostomy