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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: y 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
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y

Chronic

Topical and oral antibiotics may be prescribed if an infection is present. gentle massage of the lacrimal sac four times daily for up to nine months can drain the sac and sometimes clear a blockage. The type of antibiotic and treatment may depend on which bacteria is present. Tearing 2. As mentioned. the lacrimal sac will be removed completely. Tell the adult patient what to expect after surgery: He'll have ice compresses over the surgical site and will have bruising and swelling. If the duct does not open. In the acute form. it may need to be dilated with a minor surgical procedure. Apply warm compress for pain 3. swelling. In some cases. In extreme cases. Check the patient history for possible allergy to antibiotics before administration. pain. the duct may open by itself.1. y y y Nursing Management: 1. A sample of the pus may be collected on a swab or in a tube for laboratory analysis. 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. the symptoms can range from watery eyes. As the infant grows. surgery (dacryocystorhinostomy) to drain the lacrimal sac into the nasal cavity can be performed. If other treatments fail to clear up the symptoms. Promote good hygiene to prevent infection 2. a tiny tube (cannula) is inserted into the tear duct which is then flushed with a sterile salt water solution (sterile saline). Treatment: y y y y A warm compress applied to the area can help relieve pain and promote drainage. a blood test may reveal an elevated white blood cell (WBC) count. Intravenous antibiotics may be needed if the infection is severe. Mucus or pus present in tear sac Diagnosis: Dacryocystitis usually occurs in only one eye. In infants. 4. and redness to a discharge of pus when pressure is applied to the area between the bridge of the nose and the inner eyelids. . with a chronic infection. Emphasize the importance of precise compliance with the prescribed antibiotic regimen.

pain. Apply ice compresses postoperatively. 6. swelling. redness.5. 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 stagnation of tears bacterial overgrowth that leads to infection Lacrimal sac obstruction Accumulation of fluid in lacrimal sac s/sx: constant tearing. fever. enlarged tear sac . Monitor blood loss by counting dressings used to collect the blood.