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Dakriosistits akut,

dakriosistits kronis,
dakrioadenitis
ACUTE DACRYOCYSTITIS
CONTENTS
• Definition
• Etiology
• Predisposing factors
• Causative organisms
• Clinical picture
• Complications
• Treatment
ACUTE DACRYOCYSTITIS
Acute Dacryocystitis is an acute suppurative
inflammation of the lacrimal sac, characterised by
the presence of a painful swelling in the region of
sac.
ETIOLOGY
It may develop in two ways;
• As an acute exacerbation of chronic dacryocystitis
• As an acute peridacryocystitis due to direct
involvement from the neighbouring infected
structures such as; paranasal sinuses, surrounding
bones, dental abscess or caries teeth in the upper
jaw.
PREDISPOSING FACTORS
• Age: more common between 40-60 years
• Sex: predominantly seen in females probably
due to camparatively narrow lumen of the bony
canal
• Heridity: plays an indirect role, it affects the facial
configuration and so also the length and width
of the bony canal
• Poor personal hygeine
CAUSATIVE ORGANISMS
Commonly involved are;
• Streptococcus haemolyticus
• Pneumococcus
• Staphylococcus
CLINICAL PICTURE
It can be divided into 3 stages;
• Stage of cellulitis
• Stage of lacrimal abscess
• Stage of fistula formation
STAGE OF CELLULITIS
It is characterised by;
• Painful swelling in the region of lacrimal sac
• Swelling is red, hot, firm and tender
• Redness and oedema also spread to the lids and
cheeks
• Epiphora
• Constitutional symptoms such as fever, malaise
• When treated resolution may occur at this stage,
if untreated self resolution is rare
STAGE OF LACRIMAL ABSCESS
• Continued inflammation causes occlusion of the
canaliculi due to oedema
• The sac is filled with pus, distends and its anterior
wall ruptures forming a pericystic swelling
• In this way a large fluctuant swelling, the lacrimal
abscess is formed
• It usually points below and to the outer side of the
sac due the gravitation of pus and the presence of
medial palpebral ligament in the upper part
LACRIMAL ABSCESS
STAGE OF FISTULA FORMATION
• When the lacrimal abscess is left unattended,
it discharges spontaneously, leaving an external
fistula below the medial palpebral ligament
• Rarely, the abscess may open up into the nasal
cavity forming an internal fistula
EXTERNAL LACRIMAL FISTULA
COMPLICATIONS
• Acute conjunctivitis
• Corneal abrasion which may be converted to
corneal ulceration
• Lid abscess
• Osteomyelitis of lacrimal bone
• Orbital cellulitis
• Facial cellulitis and acute ethmoiditis
• Rarely cavernous sinus thrombosis and very rarely
generalised septicaemia may also develop
TREATMENT
During cellulitis stage;
• Systemic(ciprofloxacin or cephalosporin or
tetracycline or cotrimoxazole for 7 days) and topical
antibiotics to control infection
• Systemic anti inflammatory, analgesic drugs and
hot fomentation to relieve pain and swelling
During stage of lacrimal abscess;
• In addition to the above treatment when pus starts
pointing on the skin, it should be drained with a
small incision.
• The pus should be gently squeezed out, the
dressing should be done with betadine
• Later depending upon condition of the lacrimal
sac either DCT or DCR operation should be carried
out, otherwise recurrence will occur
During external lacrimal fistula;
• After controlling the acute infection with systemic
antibiotics, fistulectomy along with DCT or DCR
operation should be performed
REFERENCE
• A K Khurana Textbook of Ophthalmology,
5th edition
• Parsons’ Textbook of Ophthalmology, 22nd edition.
CHRONIC
DACRYOCYSTITIS
• WHAT IS DACRYOCYSTITIS?

• WHAT ARE THE CAUSES OF


CHRONIC DACRYOCYSTITIS?
Predisposing Factors
Factors causing stasis of tears
Source of infection
Causative organisms
1. Predisposing factors

• Age
• Sex
• Race
• Heredity
• Socio-economic status
• Poor personal hygiene
2. Factors causing stasis of tears

• Anatomical factors
• Foreign bodies
• Excessive
lacrimation
•Mild grade
inflammation
•Obstruction of
lower end of NLD
3. Source of infection
4. Causative organisms

• Most common –
Staphylococci,
Pneumococci,
Streptococci,
Pseudomonas
pyocyanea
STAGES

1. Stage of chronic catarrhal


dacryocystitis
2. Stage of lacrimal mucocoele
3. Stage of chronic
suppurative dacryocystitis
4. Stage of chronic fibrotic sac
1. Stage of chronic catarrhal
dacryocystitis

• Symptoms
• Lacrimal syringing –
clear fluid or few
fibrinous flakes
• Dacryocystography –
block in the NLD, normal
sized lacrimal sac with
healthy mucosa
2. Stage of lacrimal mucocoele

• Symptoms
• Dacryocystography –
distended sac with blockage
in the NLD
• Regurgitation test – milky or
gelatinous fluid
•Encysted mucocoele
3. Stage of chronic suppurative
dacryocystitis
• Symptoms
• Regurgitation test – frank
mucopurulent discharge
• Encysted pyocoele

4. Stage of chronic fibrotic sac


• Symptoms
• Dacryocystography – very
small sac with irregular
mucosal folds
COMPLICATIONS

• Chronic intractable conjunctivitis


• Ectropion of lower lid, maceration
and eczema of lower lid skin
• Hypopyon corneal ulcer
• Operative complications -
endophthalmitis
TREATMENT

• Conservative treatment – repeated lacrimal


syringing
• Balloon catheter dilation
• Dacryocystorhinostomy
• Dacryocystectomy – only when DCR is
contraindicated
• Conjunctivodacryocystorhinostomy
dacrioadenitis
Dacrioadenitis akut

• Primer : inflamasi kelenjar


• Sekunder infeksi local (trauma, konjungtivitis, seluitis orbita) atau
sistemik (mumps, influenza, meales)
• Bengkak dan nyeri di lateral kelopak mata
• Palpebra bengkak, merah S-shape
• Proptosis dan nyeri
• Terapi
• Kompres hangat
• Antibiotik, antiinflamasi dan analgetik sistemik
• Insisi dan drainase bila ada pus
Dacrioadenitis kronis

• Pembesan dan hipertropi kelenjar lakrimal


• Etiologi
• Sisa dari inflamasi akut
• Dihungkuan dengan infamasi kronis konjungtiva
• Sitemik : tuberculosis, sifilis dan sarcoidosis
• Bengkak tidak nyeri
• Bola mata bergeser turun
• Diplopia bila melihat ke atas (up-gaze)
• Palpasi
• Masa lobulated mobile di bawah kelopak mata bagian atas lateral orbita
• DD
• Fine needle biopsy
• Terapi
• Sesuai penyebab