Definition: Chronic inflammation of the lacrimal sac due to blockage of the nasolacrimal duct. It is the most common lacrimal sac disorder.


Predisposing factors:

• Blockage of the nasolacrimal duct.
Acute dacryocystitis.


Pneumococci: 80% of cases.

• Staphylococcus, Streptococcus, trachoma and fungi.

• TB and syphilis: rare.


  1. Watery eye.
  2. Discharge.


  1. Internal canthus red and hyperemic.
  2. Swelling of the lacrimal sac: under the medial eyelid band.
  3. Regurgitation test + ve: Regurgitation of mucous membranes or pus. It becomes -ve during the formation of a mucocele.


  1. Chronic conjunctivitis.
  2. Vicious cycle of epiphora, eczema and ectropion.
  3. Hypopyroid ulcer.
  4. Endophthalmitis: after intraocular surgery.
  5. Mucocele and pyocele: when the canaliculi are blocked.
  6. Acute dacryocystitis, abscess and tear fistula.


Clinical evaluation and examination of the epiphora

  1. Story: Exclude tearing.

Bilateral eye tears are usually due to tears, while unilateral tears are usually due to Epiphora.

  1. Review:

• Eyelids: Exclude trichiasis, ectropion and blepharitis.

• Lacrimal sac: swelling and dacryocystitis.

• Nose: polyps and distracted nasal septum.

  1. Investigations:
  2. Regurgitation test: positive for NLD obstruction.
  3. Jones test.
  4. Dacryocystography.
  5. Ordinary radiography: diagnosis of tumors and fractures.
  6. Tuberculin test for tuberculosis.
  7. Diagnostic examination and scintillography.
  8. 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.

  1. 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.

• Results:

  1. Cotton is dyed with patented fluorescent tear passages.
  2. Undyed: Pass the Jones Type II test.

II Type II: According to Type I, flush the tear duct with saline.

• Results:

  1. If fluorescin is obtained: The passages are partially or functionally blocked.
  2. If fluorescin is not recovered: there is complete obstruction.
  3. Dacryocystography:

Useful for the detection of the following: tumors and stones that appear as filling defects. Time to fill and empty the bag.

  1. Regular X-ray: to detect tumors and fractures.



  1. Restore the communication between the lacrimal sac and the nose.
  2. Treatment of the infection.


  1. Treatment of the cause of the obstruction.
  2. Dacryocystorhinostomy:

Principle: Connect the lacrimal sac to the nasal mucosa bypassing the blocked NLD.


Chronic dacryocystitis.

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.

  1. Dacryocystectomy:

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.


  1. Cleaner fluid, mucus or pus regurgitation test.
  2. Recurrent conjunctivitis.


  1. Hydrostatic massage: ask the mother to push the eye bag down. This can help remove epithelial remains and open the hash valve.
  2. Antibiotics.

3rd survey: high success rate.

  1. Repeated spraying and rinsing.
  2. Intubation of the tear drainage system (silicone tube).
  3. Dacryocystorhinostomy (DCR).

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