WATERING EYE, EPIPHORA, DACRYOCYSTITIS, DACRYOCYSTORHINOSTOMY

1. Dr. SOMESH.K.N

3. watering eye is characterised by
overflow of tears from conjunctival
sac.
Watering eye is mainly due to
hyperlacrimation and epiphora.

5. Causes of hyperlacrimation
Primary hyperlacrimation
Reflux hyperlacrimation
Central lacrimation

6. Epiphora(DOWN POUR)
Obstruction to the outflow of
normally secreted tears.
Epiphora may be due to
physiological (lacrimal pump
failure) or anatomical(mechanical
obstruction) cause.

7. Mechanical obstruction
Punctal causes
Canaliculi
Lacrimal sac
NLD

9. Clinical evaluation
 Ocular examination with diffuse illumination
using magnifiaction.
 Regurgitation test.
 Fluorescein dye disappearance test.
 Lacrimal syringing.
 Jones dye test.
 Dacryocystography.
 Radionucleotide dacryocystography(lacrimal
scintillography).

14. Dacryocystitis
 Dacryocystitis is an infection of the lacrimal sac
secondary to obstruction of the nasolacrimal
duct at the junction of lacrimal sac.
 Dacryon= tear, cyst= sac
 Simply dacryocystitis is an inflammation of
lacrimal sac.
 Dacryocystitis may be congenital or
acquired.

15. Congenital dacryocystitis
 Inflammation of lacrimal sac occuring in new
born infants( dacryocystitis neonatorum)
 Etiology
congenital blockage in NLD
 Clinical picture
1.epiphora
2.positive regurgitation test
3.swelling

17. Differential diagnosis
 It should be differentiated from ophthalmia
neonatorum and congenital glaucoma
Complications
 Recurrent conjunctivitis
 Lacrimal abscess
 Fistulae formation

18. Treatment
 Massage over lacrimal sac area and topical
antibiotics in first month(3-4 weeks of age).
 Lacrimal syringing (if not cured up to 2months
of age)
 Probing of NLD with Bowmans probe(if not
cured up to 3-4months)
 Balloon catheter dilatation(if probing fails)
 Intubation with silicone tube(If probings and
catheter dilation fails)
 DCR operation(final approach at the age of 4)

19. Acquired dacryocystitis
 It may be acute or chronic
Chronic dacryocystitis:
Etiology
 Etiology is of multifactorial.
 Vicious cycle of stasis and mild infection of long
duration
 Predisposing factors.
 Factors responsible for stasis of tears in lacrimal
sac(anatomical factors,foreign body,inflammation of
lacrimal sac, obstruction of NLD)

20. Clinical picture
1.chronic catarrhal dacryocystitis
 Only symptom is watering eye
 DCG reveals block in NLD, normal sized lacrimal sac
with healthy mucosa.
2.Lacrimal mucocoele
 Distension of lacrimal sac.
 Characterised by constant epiphora associated with
swelling below inner canthus.
 Milky or gelatinous fluid from lower punctum on
pressing swelling.
 DCG reveals distended sac with blockage in NLD

21.  Some times due to chronic infection, opening of both
canaliculi into sac are blocked leading to negative
regurgitation test. This is called encysted mucocele.
3.Chronic suppurative dacryocystitis
 Due to pyogenic infection, the mucoid discharge becomes
purulent, converting it into pyocoele
 Characterised by epiphora, associated recurrent
conjunctivitis and swelling at the inner canthus with mild
erythema of overlying skin.
 On regurgitation test, frank purulent discharge flows from
lower punctum. If openings of canaliculi are blocked then
encysted pyocole.

23. 4.Chronic fibrotic sac.
 Low grade repeated infections for a
prolonged period ultimately result in a small
fibrotic sac due to thickening of mucosa,
which is often associated with persistant
epiphora and discharge.
 DCG at this stage reveals very small sac with
irregular folds in mucosa.

24. Treatment
 Conservative treatment with repeated lacrimal
syringing.
 Balloon catheter dilatation(balloon dacryocystoplasty)
 DCR
 DCT
 Conjunctivo dacryocystorhinostomy

25. Acute dacryocystitis
 It is an acute suppurative inflammation
of lacrimal sac, characterised by
presence of a painful swelling in region
of sac.
 Clinical picture
stage of cellulitis
stage of lacrimal abscess
stage of fistula formation

27. Treatment
 During cellulitis stage
 During stage of lacrimal abscess
 Treatment of external lacrimal fistula
Surgical technique of DCR:
1.Conventional external approach DCR
2.Endonasal DCR
3.Endocanalicular laser DCR