Definition: Chronic inflammation of the lacrimal sac due to blockage of the nasolacrimal duct. It is the most common lacrimal sac disorder.
• Blockage of the nasolacrimal duct.
Pneumococci: 80% of cases.
• Staphylococcus, Streptococcus, trachoma and fungi.
• TB and syphilis: rare.
- Watery eye.
- Internal canthus red and hyperemic.
- Swelling of the lacrimal sac: under the medial eyelid band.
- Regurgitation test + ve: Regurgitation of mucous membranes or pus. It becomes -ve during the formation of a mucocele.
- Chronic conjunctivitis.
- Vicious cycle of epiphora, eczema and ectropion.
- Hypopyroid ulcer.
- Endophthalmitis: after intraocular surgery.
- Mucocele and pyocele: when the canaliculi are blocked.
- Acute dacryocystitis, abscess and tear fistula.
Clinical evaluation and examination of the epiphora
- Story: Exclude tearing.
Bilateral eye tears are usually due to tears, while unilateral tears are usually due to Epiphora.
• Eyelids: Exclude trichiasis, ectropion and blepharitis.
• Lacrimal sac: swelling and dacryocystitis.
• Nose: polyps and distracted nasal septum.
- Regurgitation test: positive for NLD obstruction.
- Jones test.
- Ordinary radiography: diagnosis of tumors and fractures.
- Tuberculin test for tuberculosis.
- Diagnostic examination and scintillography.
- Regurgitation test: press the tear bag against the tear bone:
• + ve Regurge: pus or tear reflux from the Puncti NLD.
• -eyes Regurge: No reflux passages.
- Jones test:
I. Type I: a
Let fluorescine fall into the conjunctival sac and place a coil on a pellet soaked in xylocaine (Usneezing reflex) under the lower nasal turbine.
- Cotton is dyed with patented fluorescent tear passages.
- Undyed: Pass the Jones Type II test.
II Type II: According to Type I, flush the tear duct with saline.
- If fluorescin is obtained: The passages are partially or functionally blocked.
- If fluorescin is not recovered: there is complete obstruction.
Useful for the detection of the following: tumors and stones that appear as filling defects. Time to fill and empty the bag.
- Regular X-ray: to detect tumors and fractures.
- Restore the communication between the lacrimal sac and the nose.
- Treatment of the infection.
- Treatment of the cause of the obstruction.
Principle: Connect the lacrimal sac to the nasal mucosa bypassing the blocked NLD.
Mucocele of the eye bag.
• Lacrimal fistula (+ fistulectomy).
• Extensive adhesions and neglected cases.
Nasal pathology, e.g. atrophic rhinitis.
• T. B. and eye bag tumors.
• Hypopyroid ulcer.
Principle: withdrawal of the eye bag.
Indications: Neglected cases where DCR is contraindicated.
Congenital obstruction of NLD (infantile dacryocystitis) etiology: imperforate rabbit flap (most common).
Symptoms: Epiphora, 2-3 weeks after birth, is reported by the mother.
- Cleaner fluid, mucus or pus regurgitation test.
- Recurrent conjunctivitis.
- Hydrostatic massage: ask the mother to push the eye bag down. This can help remove epithelial remains and open the hash valve.
3rd survey: high success rate.
- Repeated spraying and rinsing.
- Intubation of the tear drainage system (silicone tube).
- Dacryocystorhinostomy (DCR).