Introduction
Dacryocystitis is an infection of the lacrimal sac, which is a crucial component of the tear drainage system. This condition can cause significant discomfort and may lead to serious complications if left untreated.
What is Dacryocystitis?
Dacryocystitis is an inflammation or infection of the lacrimal sac, located near the inner corner of the eye, where tears drain from the eye into the nasal cavity. This infection can occur when the tear drainage system becomes blocked, leading to the accumulation of tears and subsequent bacterial growth. Infection of the tear duct occurs in both newborn infants and adults.
Approximately 6% of babies are born with congenital nasolacrimal duct obstruction (NLDO), which can lead to dacryocystitis.
Dacryocystitis Cause & Symptoms
Causes of Dacryocystitis
The primary cause of dacryocystitis is the obstruction of the nasolacrimal duct, which is the channel that drains tears from the eye into the nasal cavity. This obstruction can result from:
- Bacterial Infections: Infections caused by organisms such as Staphylococcus aureus or Streptococcus species can lead to dacryocystitis.
- Congenital Blockage: Infants may be born with a blocked nasolacrimal duct, which can result in dacryocystitis if not managed properly.
- Trauma: Injury to the eye or surrounding areas can cause inflammation and blockage of the tear drainage system.
- Chronic Conditions: Conditions like chronic sinusitis or nasal polyps can contribute to obstruction and subsequent infection.
- Age-Related Factors: In older adults, age-related changes can cause partial obstruction of the duct, increasing the risk of infection.
- Membrane: A membrane blocking the duct in newborns can lead to dacryocystitis.
- Tumours: Tumours in or around the nasolacrimal duct can obstruct tear drainage and lead to infection.
Symptoms of Dacryocystitis
Dacryocystitis can present with a range of symptoms, including:
- Pain and Tenderness: Pain and tenderness near the inner corner of the eye.
- Swelling: Redness and swelling of the area around the lacrimal sac.
- Discharge: Pus or mucus draining from the eye, which may be yellow or green.
- Fever: Systemic symptoms such as fever may occur in more severe cases.
- Tearing: Excessive tearing or watery eyes due to the blocked tear duct.
Diagnosing of Dacryocystitis
Accurate diagnosis is crucial for effective treatment. The diagnostic process typically includes:
- Clinical Examination: A thorough examination by an eye care professional to assess symptoms and the extent of swelling or tenderness.
- Imaging Studies: In some cases, imaging studies like dacryocystography (X-ray of the tear duct system) or ultrasound may be used to visualize the obstruction or infection.
- Cultures: Samples of discharge or pus may be taken to identify the causative bacteria and determine appropriate antibiotic treatment.
Dacryocystitis Treatment Surgery
Oral or Intravenous Antibiotics
The primary approach for the treatment of acute dacryocystitis involves antibiotics. These help control the infection and prevent it from spreading.
Warm Compresses and Massages
These home remedies are beneficial in alleviating symptoms and promoting drainage, especially in chronic dacryocystitis treatment.
Lacrimal Duct Probing
For chronic cases or congenital blockages, a procedure called lacrimal duct probing may be performed to clear the obstruction.
Antibiotic Eye Ointments and Drops
Topical antibiotics are often used for dacryocystitis treatment in adults, particularly for mild cases or as a supplementary measure to oral antibiotics.
Surgery for Chronic Cases - Dacryocystorhinostomy (DCR)
For persistent or severe cases, dacryocystitis surgery may be required. This procedure creates a new pathway for tear drainage, offering a long-term solution for chronic dacryocystitis.
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Epiphora
Introduction
Epiphora, commonly known as excessive tearing or watery eyes, is a condition where tears overflow from the eyes more than usual. While it may seem like a minor inconvenience, it can significantly impact daily life and indicate underlying health issues.
What is Epiphora?
Epiphora occurs when there is an imbalance between the production and drainage of tears. Normally, tears are produced to keep the eyes moist and are drained through the nasolacrimal duct into the nasal cavity. When this system is disrupted, tears can accumulate and overflow onto the cheeks, causing excessive tearing.
Epiphora in children
Numerous conditions in children may cause epiphora
Probing for congenital nasolacrimal duct obstruction
Congenital Nasolacrimal Duct Obstruction is defined as a membranous obstruction at the end of the nasolacrimal duct that can be overcome with minimal resistance or no resistance during probing of the tear drainage system. Probing of the nasolacrimal duct is performed to open the valve between the nasolacrimal duct and the nose. The surgeon first dilates (widens) the opening in the puncta (the two small holes in the eyelid) using a tiny metal dilating tool.
Topical antibiotics and hydrostatic lacrimal sac massage are standard treatments during the first few months of life. If the issue lasts, then early probing after the age of one year produces favorable results.
Dacryocystocele
Dacrocystocele is a rare but significant condition affecting the tear duct system in infants. It involves a cystic swelling that occurs due to an obstruction or malformation of the nasolacrimal duct, which is responsible for draining tears from the eyes into the nasal cavity. The condition can cause noticeable bulging and discomfort, and it often requires medical attention to manage effectively.
Diagnosing dacrocystocele involves a detailed examination by a pediatric ophthalmologist or an otolaryngologist. The doctor will assess the baby’s symptoms, perform a physical examination, and may use imaging studies such as ultrasound to visualize the cyst and determine its size and exact location.
Management of dacrocystocele depends on the severity of the condition and the specific needs of the child. Treatment options may include:
Observation
In some cases, if the dacrocystocele is small and does not cause significant symptoms or complications, the doctor might recommend a watch-and-wait approach. Regular monitoring ensures that the cyst does not grow or cause additional problems.
Massage and Hygiene
Gentle massage of the area may help in some cases, especially if the cyst is not too large. Maintaining good eye hygiene and using warm compresses can help manage symptoms and reduce the risk of secondary infections.
Probing and Irrigation
If the cyst is causing significant symptoms or complications, a minor surgical procedure called probing and irrigation may be performed. This involves inserting a small probe into the duct to clear the obstruction and restore normal tear drainage.
Surgical Intervention
In more severe cases, or if conservative measures and probing are not effective, surgical intervention may be required. Surgery typically involves removing the cyst and repairing any structural abnormalities to restore proper tear drainage.
