da c rio cystitis

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Z A L D I

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH SUMATERA UTARAMEDAN

2013

DACRYOCISTITIS

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Z A L D I DACRYOCISTITIS


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22/09/2013 23:56Z A L D I DACRYOCISTITIS2

Dengan menyebut nama Allah

Yang Maha Pengasih Maha Penyayang.


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I. TUJUAN INSTRUKSIONAL UMUM

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Setelah Proses Belajar Mengajar mahasiswa

mampu menegakkan diagnosa dakriosistitisdengan melakukan anamnese dan

pemeriksaan sederhana yang akan dipelajari

selama masa perkuliahan dengan baik danbenar .


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II. TUJUAN INSTRUKSIONAL KHUSUS


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Setelah Proses Belajar Mengajar mahasiswa

mampu mengetahui tanda dan gejala , faktorresiko, prinsip pengobatan, komplikasi, dan

mengkonsulkan secara garis besar dengan

baik dan benar kasus-kasus dakriosistitissesuai dengan kompetensinya


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PATOGENESIS

It follows stasis of secretions in the lacrimal sac due tocongenital blockage in the nasolacrimal duct. It is ofvery common occurrence. As many as 30 percent ofnewborn infants are believed to have closure of

nasolacrimal duct at birth; mostly due to membranousocclusion at its lower end, near the valve of Hasner.

Other causes of congenital NLD blockare: presence ofepithelial debris, membranous occlusion at its upperend near lacrimal sac, complete non-canalisation andrarely bony occlusion. Common bacteria associatedwith congenital dacryocystitis are staphylococci,pneumococci and streptococci.

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CLINICAL PICTURE

Congenital dacryocystitis usually presents as amild grade chronic inflammation. It ischaracterised by:

1. Epiphora, usually developing after seven days ofbirth. It is followed by copious mucopurulentdischarge from the eyes.

2. Regurgitation test is usually positive, i.e., whenpressure is applied over the lacrimal sac area,purulent discharge regurgitates from the lowerpunctum.

3. Swelling on the sac area may appear eventually

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DIFFERENTIAL DIAGNOSIS

Congenital dacryocystitis needs to be

differentiated from other causes of watering in

early childhood especially ophthalmia

neonatorum and congenital glaucoma.

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COMPLICATIONS

Recurrent conjunctivitis,

Acute on chronic dacryocystitis,

Lacrimal abscess

Fistulae formation

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TREATMENT

1. Massage over the lacrimal sac area and topical

antibiotics constitute the treatment of congenital

NLD block, up to 6-8 weeks of age.

Massage increases the hydrostatic pressure in thesac and helps to open up the membranousocclusions.

It should be carried out at least 4 times a day to

be followed by instillation of antibiotic drops. Thisconservative treatment cures obstruction in about90 percent of the infants

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3. Probing of NLD with Bowmans probe. Itshould be performed, in case the condition isnot cured by the age of 3-4 months. Somesurgeons prefer to wait till the age of 6 months.It is usually performed under generalanaesthesia. While performing probing, caremust be taken not to injure the canaliculus. Inmost instances a single probing will relieve theobstruction. In case of failure, it may berepeated after an interval of 3-4 weeks.

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ADULT DACRYOCYSTITIS

CHRONIC DACRYOCYSTITIS

Chronic dacryocystitis is more common than

the acute dacryocystitis.

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ETIOLOGY

The etiological factors can be grouped as under:

A.Predisposing factors

1. Age. It is more common between 40 and 60 years of age.

2. Sex. The disease is predominantly seen in females (80%)probably due to comparatively narrow lumen of the bony canal.

3. Race. It is rarer among Negroes than in Whites; as in the formerNLD is shorter, wider and less sinuous.

4. Heredity.It plays an indirect role. It affects the facial configurationand so also the length and width of the bony canal.

5. Socio-economic status. It is more common in low socio-economic

group.6. Poor personal hygiene. It is also an important predisposing factor

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B.Factors responsible for stasis of tears in

lacrimal sac

1. Anatomical factors, which retard drainage of

tears include: comparatively narrow bonycanal, partial canalization of membranous NLD

and excessive membranous folds in NLD

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2. Foreign bodies in the sac may block opening ofNLD.

3. Excessive lacrimation, primary or reflex, causesstagnation of tears in the sac.

4. Mild grade inflammation of lacrimal sac due toassociated recurrent conjunctivitis may block the NLDby epithelial debris and mucus plugs.

5. Obstruction of lower end of the NLD by nasal

diseases such as polyps, hypertrophied inferiorconcha, marked degree of deviated nasal septum,tumours and atrophic rhinitis causing stenosis mayalso cause stagnation of tears in the lacrimal sac.

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COMPLICATIONS

Chronic intractable conjunctivitis, acute on

chronic dacryocystitis.

Ectropion of lower lid,

Maceration and eczema of lower lid skin dueto prolonged watering.

Simple corneal abrasions may become

infected leading to hypopyon ulcer. Endophthalmitis.

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TREATMENT

1. Conservative treatment by repeated lacrimal

syringing. It may be useful in recent cases

only. Long-standing cases are almost always

associated with blockage of NLD which usuallydoes not open up with repeated lacrimal

syringing or even probing.

2. Dacryocystorhinostomy (DCR).

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ACUTE DACRYOCYSTITIS

Acute dacryocystitis is an acute suppurative

inflammation of the lacrimal sac, characterised

bypresence of a painful swelling in the region

of sac.

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ACUTE DACRYOCICTITIS

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LACRIMAL MUCOCELE

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FISTULA

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ETIOLOGY

It may develop in two ways:

1. As an acute exacerbation of chronic dacryo-cystitits.

2. As an acute peridacryocystitis due to direct

involvement from the neighbouring infected structuressuch as: paranasal sinuses, surrounding bones anddental abscess or caries teeth in the upper jaw.

Causative organisms. Commonly involved are

Streptococcus haemolyticus, Pneumococcus and

Staphylococcus.

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CLINICAL PICTURE

Divided into 3 stages:

1. Stage of cellulitis.

2. Stage of lacrimal abscess.

3. Stage of fistula formation.

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COMPLICATIONS

Acute conjunctivitis,

Corneal abrasion

Lid abscess,

Osteomyelitis of lacrimal bone, Orbital cellulitis,

Facial cellulitis and acute ethmoiditis.

Rarely cavernous sinus thrombosis and very rarely generalized septicaemia may also

develop

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TREATMENT

1. During cellulitis stage. It consists of systemic

and topical antibiotics to control infection; and

systemic anti-inflammatory analgesic drugs

and hot fomentation to relieve pain andswelling.

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REFERENCES


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American Academy of Ophthalmology, External

Disease and Cornea, Section 8, 2011-2012

Khurana AK, Comprehensive Ophthalmology, Fourth

Edition , New Delhi, New Age Internasional (p) LimitedPublisher, 2007.

Vaughan & Asbury's : General Ophthalmology

17th Edition , Mc Graw- Hills Companies , May 2007


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Segala puji bagi Allah, Tuhan semesta alam.

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