Dacryocystitis (chronic)

Question 1

Aetiology

Answer 1

Chronic dacryocystitis is inflammation or infection of the lacrimal sac secondary to chronic nasolacrimal duct obstruction.

Several presentation:

• chronic conjunctivitis, with epiphora and purulent discharge when punctum expressed
• lacrimal sac mucocoele.
• persistent epiphora and conjunctival hyperaemia

Question 2

Predisposing factors

Answer 2

Female, over 30s
Recurrent conjunctivitis
Acute dacryocystitis
Chronic nasolacrimal duct obstruction
Facial fracture
Foreign bodies

Question 3

Symptoms

Answer 3

One or more of the following
- Persistent redness, watering, tenderness, and swelling over the lacrimal sac / medial canthus
- Persistent redness over medial canthus
- Persistent painless swelling over medial canthus
- Chronic epiphora

Question 4

Signs

Answer 4

Episodes of swelling, tenderness, redness over the lacrimal sac. May release mucoid discharge when expressed.

Symptoms are similar to but less severe than acute dacryocystitis.

Question 5

Non-pharmacological management

Answer 5

Mild cases can be managed with warm compresses and massage.
Chronic dacryocystitis is treated surgically

Question 6

Pharmacological management

Answer 6

Mild cases - CPL for no less than 5 days.
Can also be given as a prophylactic when awaiting surgery.

Question 7

Refer?

Answer 7

Mild cases can be monitored with alleviation / palliation

If persistent / recurrent, refer routinely

Question 8

What can they do at hospital?

Answer 8

DCR - dacryocystorhinostomy
Dacryocystography