Lacrimal Drainage Problems and Treatments Flashcards
What is dacryocystogrpahy?
- method to determine if drainage system is open
- lacrimal sac has saline and radio opaque substance
- X-rays taken to determine blockage
Describe Dacryocystitis (What it is, how it’s caused)
- infection or inflammation of lacrimal sac
- secondary to obstruction in system
- caused by bacteria and fungi
- can be congenital or acquired
Describe congenital dacryocystitis
- complications of congential dacyostenosis
- mild to moderate tenderness on palpation
- chronic (painless) presentation for weeks
- either unilateral or bilateral
Describe acquired dacryocystitis
- unilateral presentation
- acute onset (moderate to severe pain)
- tenderness/pain at inferior inner canthus
- diffuse pain around eye and orbit
Describe signs for Acute Dacryocystitis
- swelling of sac
- localized edema and erythema throughout inferior nasal region
- purulent discharge
- secondary conjunctivitis
- severe cases, secondary preseptal cellulitis
- always have epiphora (tearing)
- Chronic is less severe than acute
You have a patient that presents with edema and erythema thoughout their inferior nasal region causing severe swelling of the sac. The patient is also constantly tearing (epiphoria). A week later they report secondary preseptal cellulitis. What is the diagnosis?
A. Acute Dacryocystitis
B. Chronic Dacryocystitis
A. Acute Dacryocystitis
How do you evaluate for Dacryocystitis work up?
- Compress lacrimal sac to get discharge (discharge = bacterial, fungal)
- check EOM’s and for proptosis
- gram stain if discharge
- consider CT scan for cases that do not respond to treatment
- NEVER DILATE/IRRIGATE during acute stage of infection
Which of the follow would you not do when evaluating acute stage dacryosystitis?
A. compress lacrimal sac for discharge B. check EOM's and for proptosis C. Perform gram stain and blood cultures D. CT Scan E. Dilate and Irrigation
E. Dilate and Irrigation
What is best way to treat a mild case of dacryosystitis for children?
A. Amoxicillin or Cefaclor
B. Hospitalization
C. Dicloxacillin or Cephalexin
A. Amoxicillin or Cefaclor
What is best way to treat a severe case of dacryosystitis or mild case with an unreliable parent?
A. Amoxicillin or Cefaclor
B. Hospitalization
C. Dicloxacillin or Cephalexin
B. Hospitalization
What is best way to treat a mild case of dacryosystitis for adults?
A. Amoxicillin or Cefaclor
B. Hospitalization
C. Dicloxacillin or Cephalexin
C. Dicloxacillin or Cephalexin
What are some non systemic dacryocystitis treatment methods?
- topical antibiotic drops
- warm compresses and gentle massage
- pain meds aceptaminophen
- Surgical correction: dacryocystorhinostomy
- daily follow up
List two type of lacrimal obstructions
- congenital 30% in new borns
- Dacryostenosis (narrowing of canaliculi)
How would you evaluate for lacrimal obstructions?
- Observation of punctal intregrity
- Drainage test (Jones)
- Dilation & irrigation
- Dacryocystorhinogram (X-ray) for serious cases
What is the treatment for lacrimal obstruction?
- Treat underlying cause
- Frequent heat and firm massage
Describe lacrimal fistula
- Chronic, untreated dacryocystitis
- inflamed lacrimal sac to the point of perforation
What is dacryocystorhinostomy
- Surgical procedure where hole is drilled in lacrimal sac and lacrimal fossa to allow drainage
Describe dacryocanaliculitis
- infection or inflammation of canaliculi
- caused by fungal infection secondary to blockage
- difficult to treat
Describe dacryolith
- yellow putty-like deposit that block drainage system
- secondary to fungal infections
You have a patient that presents with a inflamed lacrimal sac that is perforated. What is the diagnosis?
A. Lacrimal fistula
B. Dacryocanaliculitis
C. Dacryolith
D. Lacrimal Gland Tumor
A. Lacrimal fistula
You have a patient that presents with a inflamed canaluculi stemming from a fungal infection. What is the diagnosis?
A. Lacrimal fistula
B. Dacryocanaliculitis
C. Dacryolith
D. Lacrimal Gland Tumor
B. Dacryocanaliculitis
You have a patient that presents with a yellow putty-like deposits that block the drainage system and stem from a fungal infection. What is the diagnosis?
A. Lacrimal fistula
B. Dacryocanaliculitis
C. Dacryolith
D. Lacrimal Gland Tumor
C. Dacryolith
