DACRYOCYSTITIS

Definition:

Tears drain into little openings (puncta) in the inner corners of the eyelids. From there, the tears travel through little tube-like structures (canaliculi) to the lacrimal sac. The nasolacrimal ducts then take the tears from the lacrimal sac to the nose. That's why people need to blow their nose when they cry a lot.

Dacryocystitis is usually caused by a blockage of the nasolacrimal duct, which allows fluid to drain into the nasal passages. When the lacrimal sac does not drain, bacteria can grow in the trapped fluid. This condition is most common in infants and people over 40 years old.

Dacryocystitis is an infection of the lacrimal sac. In infants, it results from congenital atresia of the nasolacrimal duct. In adults, it results from an obstruction (dacryostenosis) of the nasolacrimal duct (most often in women over age 40 years). Dacryocystitis can be acute or chronic.

Signs and Symptoms:

constant tearing – hallmark sign of both acute and chronic dacryocystitis

Acute

1. Pain, swelling, redness, and tenderness over the tear sac 2. Pus may be present

Chronic

1. Tearing 2. Mucus or pus present in tear sac

Diagnosis:

Dacryocystitis usually occurs in only one eye. As mentioned, the symptoms can range from watery eyes, pain, swelling, and redness to a discharge of pus when pressure is applied to the area between the bridge of the nose and the inner eyelids. A sample of the pus may be collected on a swab or in a tube for laboratory analysis. The type of antibiotic and treatment may depend on which bacteria is present. In the acute form, a blood test may reveal an elevated white blood cell (WBC) count; with a chronic infection, the WBC count is usually normal. To identify the exact location of the blockage, an x ray can be taken after a dye is injected into the duct in a procedure called dacryocystography.

Treatment:

A warm compress applied to the area can help relieve pain and promote drainage.

Topical and oral antibiotics may be prescribed if an infection is present.

Intravenous antibiotics may be needed if the infection is severe. In some cases, a tiny tube (cannula) is inserted into the tear duct

which is then flushed with a sterile salt water solution (sterile saline).

If other treatments fail to clear up the symptoms, surgery (dacryocystorhinostomy) to drain the lacrimal sac into the nasal cavity can be performed.

In extreme cases, the lacrimal sac will be removed completely. In infants, gentle massage of the lacrimal sac four times daily for

up to nine months can drain the sac and sometimes clear a blockage. As the infant grows, the duct may open by itself. If the duct does not open, it may need to be dilated with a minor surgical procedure.

Nursing Management:

1. Promote good hygiene to prevent infection2. Apply warm compress for pain

3. Check the patient history for possible allergy to antibiotics before administration. Emphasize the importance of precise compliance with the prescribed antibiotic regimen.

4. Tell the adult patient what to expect after surgery: He'll have ice compresses over the surgical site and will have bruising and swelling.

5. Monitor blood loss by counting dressings used to collect the blood.

6. Apply ice compresses postoperatively. A small adhesive bandage may be placed over the suture line to protect it from damage.

Pathophysiology:

Etiology: obstruction secondary to mucocele

of the lacrimal sac

Precipitating factors: chronic blockage of the

interosseous or intermembranous nasolacrimal duct

nasolacrimal duct obstruction

chronic mucosal degeneration

Ductile stenosis

Lacrimal sac obstruction

bacterial overgrowth that leads to infection

stagnation of tears

Accumulation of fluid in lacrimal sac

s/sx: constant tearing, pain, redness, swelling, fever, enlarged tear sac