ANATOMY AND FUNCTION OF THE LACRIMAL SYSTEM:
Tears are produced by the lacrimal glands and spread by the lids. Transport of tears is through the puncta, canaliculi, lacrimal sac and nasolacrimal duct which opens into the inferior meatus of the nose.
Types :
1. Congenital
2. Acquired
2. Acquired
A) Primary acquired NLDO- No cause
B) Secondary obstruction due to
B) Secondary obstruction due to
Injuries to the bone
Infection causing canaliculitis
Neoplasms
Autoimmune disease, Chemotherapy and radiotherapy causing inflammation
ROPLAS TEST
This is the first step to performed if watering is noticed
Reflex of clear watery fluid seen in atonic sac
Reflex of mucoid fluid shows obstruction but no infection
Reflex of mucopurulent material shows presence of infections.
FACILITIES AVAILABLE IN DR.AEH
Probing
Dacryocystectomy
Dacryocystorhinostomy
Intubation
Criggler Massage
Tear duct obstruction is sometimes seen in normal infants which will open spontaneously within 1 year of age during this time simple downward massage is adequate.
PROBING
If NLDO persist beyond age 1, probing is performed under general anaesthesia or local anaesthesia
DACRYOCYSTORHINOSTOMY
Here a bypass is made between the sac and the middle meatus of the nose by making an opening in the intervening bone.
POST OP RECOVERY AND CARE
In most cases, pain is not significant and usually controlled with ice compresses and analgesics. Keep your head slightly elevated and apply cold compresses You should refrain from nose-blowing, straining, stooping, and lifting heavy objects Nose bleeds are extremely rare but can occur which can be controlled by keeping icepacks
DCR is successful in vast majority of cases and the result is usually permanent but occasionally revision and adjustments may be necessary