Acute Primary Dacryocystitis, Shalakya Tantra

ACUTE PRIMARY DACRYOCYSTITIS 

it is an acute suppurative inflammation of Lacrimal sac, commonly observed as a complication of chronic dacryocystitis (some times occur spontaneously ) 

Causative agents :Strepto cocCus haemolyticus, pneumo cocus and staphylo coccus aureus.  Patholoy:-The sac get full with frank pus, infection also spreads to periphery and causing pericystitis, finally lacrimal abscess forms, that bursts on the skin and cause Lacrimal fistula, as soon as pus drained out the inflammation subsides. 

Symptoms :Severe pain, hot sensation over the sac area, fever and watering of eye. 

Signs :1) Marked swelling, tenderness, hot and redness over the sac area 

(2) oedema of eyelids 

(3) No regurgitation of sac contents through punctum 

(4) chemosis of conjunctiva 

(5) Enlargement of sub maxillary lymphgtands 

(6) Formation of Lacrimal abscess, that may burst and cause lacrimal fistuta 

(7) Patient feels comfort after pus discharge. 8) If the condition is not treated it recurs after some time with complications. 

Complications : 

1) Osteomyelitis of Lacrimal bone 

2) Lacrimal fistula may open into nose 
3) Orbital cellulitis
4) Facial cellulitis 
5) Cavernous sinus thrombosis 

Treatment 

a) Before abscess Formation 

1) Hot compress over the sac area 

2) Systemic and Local Broad spectrum antibioics. 3) Analgesic 
4) Symptomatic treatment 

b) When Abscess formed
1) Vertical incision over sac area to drain the pus 2) Dacryo-cystectomy 

c)After fistula formation 
1) Excision of Fistulous passage 
2) Dacryo cystectomy or dacryo cystorhinostomy 

Secondary Dacryocystitis
 In infants :due to tuberculosis or syphilitic affections of surrounding bones. 

In adults :
a) Trachoma
b) Tuberculous or Syphilitic affections 
c) Leprosy. 

Treatment :Causative diseases should be treated, local and symptomatic treatment should give.