Acute dacrocystitis

Acute dacrocystitis

ACUTE DACRYOCYSTITIS...

 It is an acute suppurative inflammation of lacrimal sac , characterised by presence of painful swelling in the region of sac..
ETIOLOGY,
1. As an acute exacerbation of chronic dacryocystitis..
2. As an acute peridacryocystitis due to direct involvement from the neighbouring infected structures ..



Causative organisms are streptococus haemolyticus,pnemococus, staphylococus...

CLINICAL PICTURE:
it is divided into 3 stages
1. Stage of cellulitis... It is characterised by a painful swelling in the region of lacrimal sac epiphora , fever , malaise.. Swelling is red hot firm and tender. If treated resolution occurs at this stage..
2. 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 pericystitic swelling.. It points below and to outer side of the sac.
3. Stage of fistula formation... When lacrimal abscess is left un attende it discharges spontaneously leaving external fistula. Abscess may open up into nasal cavity forming an internal fistula ..
COMPLICATION.....
1. Acute conjunctiva 2. Corneal abrasion 3. Lid abscess 4.orbital cellulitis.

TREATMENT......
1. During cellulitis stage... Systemic topical antibiotics, analgesic drugs ,hot fomentation to relieve pain and swelling..
2. During stage of lacrimal abscess ... When pus starts coming out on skin it should be drained with small incision.. It should be squeezed out and dress it with betadine guaze .
        Later on DCT OR DCR is done..
3. Treatment of external lacrimal fistula..... After controlling the acute infection with systemic anti biotics fistulactomy along with DCT or DCR  operation is performed..
SURGICAL TECHNIQUE of DCR  conventional external approach DCR.
1. Anaesthesia... General
2.skin incision... Curved incision along lacrimal crest or straight incision medial to medial canthus.
3. Exposure of medial palpebral ligament and anterior lacrimal crest..
4.dissection of lacrimal sac..  Periosteum is separated from anterior lacrimal crest.  5.exposure of nasal mucosa.. Bony osteum is made exposing nasal mucosa.
6. Preparation of flaps of sac.. A probe is introduced into sac through lower canaliculus and sac is incised vertically.. To prepare flaps this incision is coverted got H shape..
7. Fashioning of nasal flaps  is also done by vertical incision converted into H shape..
8. Suturing of flaps..  Posterior flap of nasal mucosa is sutured with posterior flap of sac using 6 vicryl.
9. Closure...