Dacryocystitis/ Puyalasa/ Puyasrava, Shalakya Tantra

Dacryocystitis (Puyalasa or puya srava)

 it is the inflammatory condition of the Lacrimal sac

Dacryo Cystitis :

1) Congenital (in the new born)

2) Primary- {Chronic, Acute

3) Secondary { in Adults, in Infants.

I) Congenital dacryocystitis :This condition is due to failure in canalization of Naso Lacrimal duct, the iumen being blocked by epithelial debris

Signs :(1) Epiphora (Watering of eye)

2) Muco purulent discharge through punctum by pressing over the-sac area.

3) Slight distention of Lacrimal sac

4) The discharge is sterile at first later becomes infected

Symptoms :-Discomfort, watering , foul sticky discharge at inner canthus

Treatment. :1) Sharp pressure over the sac area, 5 to 6 times a day to evacuate the pus and has to put antibiotic drops,

2) By gentle pressure over sac area may force the sac contents down, thus the patency of Naso Lacriamal duct is achieved.

3) Probing of Naso Lacrimal duct has to do, if delayed causes cicatrical obliteration of duct

ll) Chronic primary dacryocystitis Predisposing factor :Stricture of Naso Lacrimal duct due to narrowing of bony canal assocaited with inflammed nasal mucosa, Hypertrophied inferior

turbinate, deviation of Nasal septum and by the pressure of the Nasal polyp etc.

Exciting factor : Infection of stagnated sac contents by the pneumo coccus, streptococcus and staphylo coccus.

Pathology : Because of stagnation of sac contents followed by the infection, the sac epithelium thickens and becomes atonic, the sac contents are at first watery, later on mucoid, afterwards become muco purulent. 

Symptoms :Epiphora and discomfort at inner canthus.
Sign : Can be discribed in 3 stages 

1) Catarrhal State ;Watering of eye, conjunctival hyperaemia at affected inner canthus, little regurgitation of fluids through punctum by pressing over the sac area, on syrenging fluid regurgitates with flakes of mucus through punctum, noiocal swelling on the sac area is found. 

2) mucocele stage :Watering of eyes, conjunctival hyperaemia 
Swelling area with no tenderness, mucoid material comes through punctum when pressed over the sac area and some times both lacrimal canaiiculi may be blocked and sac contents are retained (No regurgitation through punctum) Known as encysted mucocele. 

3) Pyocele or suppurative stage :epiphora, increased conjunctival hyperaemia, mucopurulent discharge comes through punctum when pressed over the sac area. 

Complications :Actue dacryocystitis, corneal ulcer, chronic conjunctivitis 

Treatment : 1)Probing the Naso lacrimal duct and syringing the sac with antibitic solution llike pencillin 50000 units /cc of distilled water, if the disease is not controlled, surgical correction has to do by following method. 

1) Dacryocystectomy (Sac is removed, life long epiphora remained). 

2) Dacryo cystorhinostomy (medial wall of the sac is anastomosed with the mucous membrane of the middle meatus of nose)