08 infection lacrimal
TRANSCRIPT
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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 ofsulphur 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 dacryocystitisEpiphora and chronic or recurrent unilateral conjunctivitis
Expressed mucopurulent material Painless swelling at inner canthus
Treatment - DCR
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Dacryocystorhinostomy