DACRYOCYSTITIS

• Dacryocystitis means the inflammation of the lacrimal sac. It may occur in two forms- Congenital and Adult Dacryocystitis
• Congenital Dacryocystitis is an inflammation of the lacrimal sac occurring in newborn infants
• Adult Dacryocystitis may occur in an acute or a chronic form. It is an acute suppurative inflammation of the lacrimal sac, characterised by the presence of painful swelling in the region of the sac

Congenital Dacryocystitis

• Congenital blockage in the nasolacrimal duct
• Common bacteria -Staphylococci, Pneumococci and streptococci

Adult Dacryocystitis

Chronic Dacryocystitis

• Age: 40 - 60 years of age
• -predominantly seen in females
• Low socio-economic group
• Poor personal hygiene
• Anatomical factors, which retard drainage of tears

Acute Dacryocystitis.

• Acute exacerbation of chronic Dacryocystitis
• From the neighbouring infected structures

Congenital Dacryocystitis

• Epiphora- copious mucopurulent discharge from the eyes
• Regurgitation test is usually positive, i.e. when pressure is applied over the lacrimal sac area, purulent discharge regurgitates from the lower punctum
• Swelling on the sac area

Chronic Dacryocystitis

Divided into four stages:

Stage of Chronic Catarrhal Dacryocystitis

• Watering eye is the only symptom and sometimes mild redness in the inner canthus
• On syringing the lacrimal sac, either clear fluid or few fibrinous mucoid flakes regurgitate

Stage of lacrimal mucocele

• Epiphora associated with a swelling
• Regurgitation test- Milky or gelatinous mucoid fluid

Stage of Chronic Suppurative Dacryocystitis.

• Due to pyogenic infection, the mucoid discharge becomes purulent, converting the mucocele into pyocoele
• On regurgitation, a frank purulent discharge flows from the lower punctum

Stage of the chronic fibrotic sac

• Small fibrotic sac due to thickening of the mucosa, which is often associated with persistent epiphora and discharge

Acute Dacryocystitis

Divided into 3 stages:

Stage of cellulitis.

• Painful swelling in the region of the lacrimal sac
• Epiphora
• Fever and malaise

Stage of lacrimal abscess

• The sac is filled with pus, distends and its anterior wall ruptures forming a pericystic swelling

Stage of fistula formation

• An external fistula discharges spontaneously

Complications

• Recurrent conjunctivitis
• Lacrimal abscess and fistulae formation.

• Examination of lacrimal sac -Swelling on the sac area
• Regurgitation test -discharge flows from the lower punctum

Congenital Dacryocystitis

• Massage over the lacrimal sac area and topical antibiotics
• Lacrimal syringing with normal saline and antibiotic solution
• Dacryocystorhinostomy (DCR) operation

Chronic Dacryocystitis

• Conservative treatment by probing and lacrimal syringing
• Dacryocystorhinostomy (DCR)
• Dacryocystectomy (DCT)

Acute Dacryocystitis

• Systemic and topical antibiotics to control infection
• Systemic anti-inflammatory analgesic drugs
• Surgery - Dacryocystorhinostomy

AyurvedicTreatment

• Pay special attention as the symptoms worsen suddenly

Internal medicines

• Amruthothara Kashaya
• Guduchyadi Kashaya
• Amrutharishtam
• Sudarsanam gutika

Procedures

• Clean the eyes with Triphala kashaya – in Pus discharge
• Sekam - Yasti and Triphala kashaya
• Purambada -Mukkadi Gutika + milk – in swelling of the eyelid
• Triphala kashaya kshalana – in ulcers
• Jatyadi Gritha –Application over the wound and not in eyes
• Chronic Nature – Jaloukavacharana