Lacrimal Duct Repair

Dacryocystitis is inflammation of the lacrimal sac. This condition includes pain, redness, and swelling along the inner corner of the eye against the nose. This is the location of the lacrimal sac, which is part of the nasolacrimal duct (tear drainage system). This condition most commonly is present when there is obstruction in the tear drainage pathways or a stone in the lacrimal sac.

This condition is treated with oral or IV antibiotics, depending on the severity, sometimes with hospitalization. Incision and drainage of the abscess may be necessary. Surgical correction of the underlying abnormality, if present, is usually necessary once the infection has resolved. This would typically involve a procedure known as dacryocystorhinostomy (DCR).

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Tears are made primarily by the lacrimal gland, which is anatomically located in the upper lateral aspect of the upper eyelid. With each blink, however, tears are drained from the eye through the tear drainage system, into the nose. There are normally two openings to the tear drainage system; one in the upper eyelid and one in the lower eyelid. These tiny orifices are situated along the margin of the eyelid, closest to the nose, and are known as puncta. The puncta lead to tiny ducts known as canaliculi which lead to the lacrimal sac, situated just along the inside corner of the eye, on the side of the bridge of the nose. Tears are carried from the lacrimal sac down the nasolacrimal duct into the nose. It is usually toward the bottom of the nasolacrimal duct that obstructions of this passageway occur.

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When an individual develops tearing due to acquired obstruction of the nasolacrimal (tear) duct, a DCR procedure is usually offered. However, diagnosis of the condition must be made first, and this usually requires one or more in-office tests by the ophthalmologist. This may include a dye disappearance test, whereby fluorescein dye is placed on the eye surface, and the disappearance between the two eyes compared. A second test for obstruction of the nasolacrimal duct might include irrigation of the tear drainage pathways. This non-painful test is completed by placing a small, blunt irrigating syringe just inside the initial opening of the tear duct, and irrigating fluid (water or saline) through the tear drainage system. If the nasolacrimal duct is determined to be relatively or completely obstructed, a DCR procedure is often appropriate.


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