What is Dacryocystitis?

Dacryocystitis generally appears as chronic and acute, with chronic being the most common. Acute dacryocystitis is often an acute attack of chronic dacryocystitis, which is caused by infections with highly virulent bacteria such as streptococcus or mixed pneumococcus. Dacryocystitis is caused by trachoma, chronic conjunctivitis or chronic rhinitis for a long time, which affects the nasolacrimal duct mucosa and causes nasolacrimal duct obstruction.

Basic Information

English name

dacryocystisis

Visiting department

Ophthalmology

Multiple groups

Middle-aged and elderly women in rural areas

Common locations

Lacrimal sac area

Common causes

unknown

Common symptoms

Tears with purulent discharge at the tear spots

Contagious

no

Causes of dacryocystitis

The exact cause is still inconclusive. Dacryocystitis is often secondary to adjacent tissues such as inflammation of the conjunctival nasal cavity and paranasal sinuses, or some special infections such as tuberculosis or syphilis. It is unclear why it originated in the lacrimal duct system.

Dacryocystitis clinical manifestations

Acute dacryocystitis

Generally, the skin of the lacrimal sac area at the base of the nose will appear red, swollen, hot, and painful, and even swollen on the same side, sometimes accompanied by swelling and tenderness of the lymph nodes in front of the ears and submandibular, tears in the eyes, and pus in small spots. Sexual secretions overflow, and when the abscess is confined, it can rupture from the skin. Usually most patients have a history of chronic dacryocystitis.

2. Chronic dacryocystitis

Mostly manifested as tears. Squeezing the lacrimal sac area can see a lot of purulent or serous secretions from the tear spots, and the lacrimal tract is not flushed.

Dacryocystitis examination

Blood test

A routine blood test for acute dacryocystitis can clarify the extent and nature of the infection.

2. Bacterial culture and drug sensitivity test of lacrimal sac secretion

Identify the nature of the infection and the types of pathogenic bacteria, and provide important references for drug treatment.

3. Pathological examination

4.CT inspection

Chronic dacryocystitis, when forming cysts, appears as a circular or quasi-circular cystic water-like density shadow, and the density of the abscess is slightly higher than the density of water. Enhanced scans have varying degrees of circular enhancement.

5. Dacryocystography

After flushing the lacrimal duct and compressing the lacrimal sac, 20% lipiodol or 60% diatrizoate 1 to 2 ml was injected through the lacrimal dots. The residual contrast agent of the conjunctival sac was removed, and the orbital and lateral images were taken to observe the contrast agent filling. Happening.

Dacryocystitis diagnosis

1. Tears, conjunctival congestion in the palate, eczema on the skin.

2. Squeezing the lacrimal sac with your fingers, mucus or purulent discharge comes out of the tear spots.

3. Due to the accumulation of a large amount of secretions, the lacrimal sac gradually expands, and the sac-like bulges appear below the medial condylar ligament.

4. CT examination, pathological examination, dacryocystography and so on are helpful for diagnosis.

Dacryocystitis treatment

The basic principle of treatment is to remove lacrimal sac infection and establish an intranasal drainage channel.

Drug treatment

Apply various antibiotic eye drops topically, 3 to 4 times / day, squeeze the fluid to drain the lacrimal sac secretion before dripping, so that the liquid can be inhaled into the lacrimal sac; with sulfa or antibiotics throughout the body, purulent discharge can disappear, Cannot be unblocked and retained as preparation for surgery.

2. Rinse the lacrimal duct

In order to completely remove purulent or mucusous secretions, the lacrimal sac can be rinsed with normal saline, and then 0.3 to 0.5 ml of antibiotics are injected. Rinsing with a mixture of antibiotics adrenocortical hormone and cellulose-dissolving fluid can have a better effect on early obstruction without fixed scars.

3. Lacrimal intubation

For patients with obstruction at the nasolacrimal duct, lacrimal intubation can be considered. First explore the lacrimal duct, then expand the lacrimal duct, and place the lacrimal duct.

4. Dacryocystorhinostomy

The local nasal mucosa and lacrimal sac are anastomosed together to establish a channel for draining tears.

5. Lacrimal sac removal

The indication should be selected according to the situation: patients with atrophic rhinitis, lupus, tuberculosis, syphilis, inflammation of the tissues around the lacrimal sac or ethmoid sinus suppurative inflammation, malignant tumors, corneal inflammation, endophthalmitis, eye trauma, etc. .