Dacryocystitis (dacryocystitis) general performance of the chronic and acute two, but the most common chronic, acute dacryocystitis (acute dacryocystitis) is often acute exacerbation of chronic dacryocystitis, due to strong poisoning bacteria such as Streptococcus or mixed infections caused by Streptococcus pneumoniae, etc. can be no history of epiphora and sudden. dacryocystitis people long suffering trachoma, chronic conjunctivitis or chronic rhinitis, it will involve the nasolacrimal duct mucosa, causing nasal lacrimal duct obstruction. tear accumulate in the lacrimal sac, the tears will continue to flow, such as being cold winds, lacrimal gland secretion will increase, so the tears can be more.
Introduction Alias ??disease: chronic dacryocystitis respective parts: eye treatment sections: ophthalmology, ENT signs and symptoms: nasal discharge, epiphora due to nasolacrimal duct obstruction or stenosis caused by this is a relatively common eye disease, occurs in the older women, more common in rural and remote areas
Epidemiology In addition to age of onset neonatal dacryocystitis due to the special developmental abnormalities caused by other than the more commonly occurs in middle age, old age than children and young people, aged 50, the highest incidence.
Dacryocystitis No difference in sexual orientation of the newborn. Dacryocystitis while adult women are more accounted for 75% to 80%, probably female bone narrow nasolacrimal duct diameter, larger nasal index (nasal index = nasal breadth * 100 / nose high) or less of women crying and blowing your nose lead to tear stagnation in terms of race, blacks less than whites. X-ray examination of the nasolacrimal duct black short and wide, larger cavities. yellow nasal index as large, may suffer from the lacrimal sac There are many cases of inflammation is greater genetic expression, genetic autosomal dominant manner, but there are variations, but only women who passed. genetic structure mainly affect the shape of the nasolacrimal duct, such as size and shape, etc., is happening lacrimal sac inflammation of the anatomy.
Inflammation The exact cause has not been determined dacryocystitis usually secondary to adjacent tissues such as the conjunctiva, nasal cavity and paranasal sinus inflammation,
Neonatal dacryocystitis Or some specific infections such as tuberculosis or syphilis etc. primary in the lacrimal system are, is unclear. Normally tears tract integrity, tear drainage unobstructed, have some antibacterial tear, not prone to inflammation of the lacrimal sac is an important predisposing factors are tears tear duct obstruction caused by retention. is not the beginning of organic obstruction, but because of a temporary nasolacrimal duct mucosa congestion and edema, while living in membranous nasolacrimal bony canal, the mucous membrane of blood vessels, lymphatic rich, a little swelling can cause obstruction, retention of the lacrimal sac contents easy to bacteria, bacterial infection, inflammation of the mucous membrane is more to promote congestion and edema, a vicious cycle if bacterial virulence is not strong, sustained chronic inflammation of the lacrimal sac, nasolacrimal duct to form the final fixity blocking drugs whenever the bacteria into the lacrimal sac and strong, the majority of infections can cause acute attacks from neighboring nasal cavity, paranasal sinuses or the lacrimal sac surrounding tissue non-specific main bacterial dacryocystitis Streptococcus pneumoniae, followed by grapes bacteria, Escherichia coli bacteria and Mo Lake, a small number of Pseudomonas aeruginosa or gonorrhea have a variety of factors affect this process: 1. nasolacrimal duct anatomy variations in bone more than others are more narrow, especially low, flat nose or face narrow, its diameter small, slight swelling of the mucosa can lead to obstruction. developmental stages of incomplete nasolacrimal duct pipe or mucosal folds of mucous membrane forming the lumen diameter would be too small to allow the swelling completely blocked.
Tissue diseases affect Nearby tissue disease as a disease affecting nasal turbinate hypertrophy or nasal septum deviation lower end of the nasolacrimal duct can lead to mechanical obstruction, nasal inflammation such as acute, peripheral, proliferative or suppurative inflammation, infection can spread directly to the tear duct may also stimulate mucosal swelling, causing the lower nasolacrimal duct obstruction, atrophic rhinitis, the mucous membrane atrophy, lower nasolacrimal duct expansion, this infection can spread directly upward, blowing your nose more easily when infectious secretions into the nasolacrimal duct, and cause dacryocystitis. paranasal sinus and has a close anatomical relationship between the lacrimal sac, the inflammation is an important reason for dacryocystitis caused, in particular, ethmoid sinus. lacrimal bone often gasification ethmoid bulla bone thin as paper, or even lacunae interlinked, the infection can spread to the lacrimal sac which directly, or through the lacrimal sac surrounding rich in blood vessels or lymphatic spread from the conjunctiva to the lacrimal sac infection spread down by less, unless some invasive diseases such as trachoma. 3 systemic infections such as influenza, scarlet fever, diphtheria, tuberculosis, etc., may be spread by blood-borne 4. excessive tear secretion and tear of the lacrimal sac can remain tension decreased, while the chronic irritation, lacrimal sac wall to reduce resistance, susceptible to bacterial invasion and inflammation of the 5 foreign bodies such as the entry point from the lacrimal from the eyelashes or the nasolacrimal duct into the nasal cavity foreign bodies may cause dacryocystitis.
Pathogenesis Retention and then tear caused by bacterial infection, more common in pneumococci, the majority of local non-granulomatous inflammation occurred while due to tuberculosis, syphilis, leprosy caused by systemic or local tissue granulomatous inflammatory disease occurred.
Diagnosis (A epiphora, conjunctival hyperemia inner canthus, the skin often eczema. (Two finger squeeze the sac to the Ministry, sticky mucus or purulent discharge from the lacrimal points out. (C may be due to large accumulation of secretions, tears the gradual expansion of the capsule, cystic medial canthal ligament below the bulge.
Symptom Eye tears may be due to relaxation of the lower eyelid skin, blinking eyes, not enough input oculi muscle strength lacrimal sac, tears into the nasal cavity can not be due. Lacrimal blockage is not due or because the tears of valgus. Watery eyes Cold tears and tears can be divided into two types: 1 Cold tears: the eyes are not red, often in tears, when the wind even more tears thin, if not treated, over time, will make the eyes dark, the color Bianbu Qing 2. tears: eye swelling and pain, afraid of meeting light, tears, sticky and dirty, and more concurrent with the other eye. eye often tears are basically three kinds of reasons: 1. Tears of valgus. Tears leave the eye point, [the tears can not flow into tears point, the occurrence of symptoms of tears 2. Lacrimal stenosis or occlusion. Because of blepharitis, burns and other trauma, or lashes into the canalicular cause. Have congenital symptoms. 3. Canalicular stenosis or occlusion. Usually caused by scar tissue after trachoma infection, stones or eyelashes into the disease. Diagnosis of typical symptoms: 1. Yingfengliulei. One or both eyes, when the temperature drops or cold stimulation, the tears flow quickly, accompanied by itching and eyes astringent feeling. 2. Often tears. Eyes in case of no stimulation often tears, tears thin clear, no pain no swelling in the eye of the outside top of a lacrimal gland, usually it continue to secrete tears to wet the surface of the eye, the cornea remain transparent, vision clear. People suffering from long trachoma, chronic conjunctivitis or chronic rhinitis, it will involve the nasolacrimal duct mucosa, causing nasal lacrimal duct obstruction. tears accumulate in the lacrimal sac, the tears will continue to flow, such as by cold winds, lacrimal gland secretion will increase, so the tears can be more of Chinese medicine, Yingfengliulei mainly due to liver and kidney, kidney qi is not satisfied, due to external stimulation by cold. lacrimal fluid as one of five persons, if more than tears long, difficult Resolution to identify, or even blindness. visible, Yingfengliulei is not a minor illness, and early treatment should be of clinical medicine on the use of high concentration of pure active ingredients, with a strong penetrating power, Liver Xiehuo, eyesight pain, blood Sanjie, inside the eye to promote metabolism, enhance the antioxidant capacity of the purpose of the crystal, the crystal protein denaturation and thus inhibiting the occurrence and development, improve the degree of lens opacity. why some people appear Yingfengliulei it? We all have the lacrimal gland produces tears and discharge The lacrimal tear (including lacrimal points, canaliculus, lacrimal sac and nasolacrimal duct in normal circumstances, tears secreted by the lacrimal gland, part evaporated, then part of the lacrimal duct into the nasal cavity through Some people are cold more sensitive to stimulation, when the eyes were cold stimulation, enhanced secretion of the lacrimal gland, they secrete more tears while experiencing cold wind canalicular stimulation, its the spasm of the sphincter contraction, so that was relatively thin canalicular, too much can not be discharged immediately tear, tears appeared to facilitate the work of the phenomenon in fact this phenomenon is produced by the lacrimal gland to cold stimulation of a protective physiological response to disease Yingfengliulei serve functional addition , there are few people as suffering from trachoma, chronic conjunctivitis, lacrimal inflammation (such as chronic dacryocystitis, etc., abnormal position of lacrimal points, may lead to lacrimal duct stenosis or obstruction, leaving the discharge of tears impeded so , although there will be tears in the indoor symptoms (or rather, should be called 'epiphora', encountered heavy wind will be more for the former functional Yingfengliulei, coupled with acupuncture, heat, or traditional Chinese medicine, but also may be appropriate to use antibiotic eye drops, such as chloramphenicol eye drops and other eye while the eye because the latter caused by tearing, should go to hospital for detailed examination, the doctor's advice in a timely manner according to the treatment, in addition to medical treatment, Some eye diseases (such as chronic dacryocystitis not based on medical history and symptoms, and consider the specific circumstances of surgery, such as, not only in tears of patients with chronic dacryocystitis, and squeeze the bridge of the nose with your fingers Department of big corner office, there will be purulent secretion material squeezed out of its secretions contain a lot of bacteria, once the person's eye needs to be done by eye trauma or surgery, it is easy to cause infection, so medical treatment for chronic dacryocystitis in ophthalmic surgery to be considered invalid .
Inspection 1 blood test for blood when acute dacryocystitis routine examination can confirm the extent and nature of the infection.
Blood test 2. Lacrimal secretions of bacterial culture and drug sensitivity test clearly the nature of infection and the types of pathogens, and provide an important reference for drug therapy 3. Histopathological examination of chronic inflammation of the lacrimal sac, the wall fibrosis, thickening up to normal 2 to 3 times the cavity is extremely narrow, but expanded into a mucous cyst wall was extremely thin mucosa rough velvet-like, fold increase in granulation group or filled cysts or polyps can cause complete obstruction of the lower lacrimal sac . submucosal tissue and inflammatory cell infiltration, with acute and chronic level of its cell components vary in different acute phase of polymorphonuclear leukocytes and lymphocytes, chronic phase of monocytes, eosinophils, plasma cells and epithelioid cells , duration of the elderly are fibroblasts. submucosa elastic tissue is replaced by fibrous tissue, scar tissue formation of cysts reduced, lacrimal sac and nasolacrimal duct connections to fibrous-like occlusion of the lacrimal sac fistula mucosal surface of epithelium and epidermis continuous with a large number of plasma cell infiltration around the fistula, fistula early discharge of pus for a long time, the acute inflammation subsided into a watery fluid. 1.CT check other laboratory examinations: the formation of cysts of chronic dacryocystitis, the performance of round or round cystic opacity, the density slightly higher than the water abscess density enhanced scan with varying degrees of ring enhancement. CT calcification and small stones can also be displayed, showing the high density spots can be found in other orbital bone hypertrophy and destruction to change. CT angiography is the lacrimal sac contrast agent injected into the system, while the CT scan shows the inner structure can be found in nasolacrimal duct obstruction, stenosis and location and degree of expansion of the lacrimal system and display and orbital soft tissue, nasal and orbital structure of the paranasal sinus disease. There are authors reported lacrimal stenosis, occlusion of the CT correctly diagnosed 95.6% 2. lacrimal imaging: the lacrimal, lacrimal sac, the The lacrimal point into the 40% iodized oil or 60% diatrizoate 1 ~ 2ml, residual contrast agent wiped the conjunctival sac, photo orbital, lateral image, observe the filling of contrast agent. relative to CT in terms of more cost-effective .
Complication Chronic dacryocystitis due the accumulation of pus, which often toxic and strong growth of bacteria, especially Streptococcus pneumoniae and Streptococcus easy to breed into the conjunctival sac of pus often, leading to chronic inflammation of the conjunctiva, cornea slightly when the trauma, or intraocular surgery, can cause corneal ulcers or creeping line purulent endophthalmitis because of the existence of this potential risk must be treated before intraocular surgery of chronic dacryocystitis should be routine lacrimal examination, especially those who have epiphora and, if abnormal, surgery should be made before surgery, nasal drainage or removal of the lacrimal sac, in emergency intraocular surgery, tears on the point of coagulation should be closed. Acute dacryocystitis often complicated by acute conjunctivitis, marginal keratitis, etc. For Streptococcus pneumoniae, can cause serpiginous corneal ulcer case of streptococcal infection spread to the lacrimal sac surrounding tissue, can lead to facial erysipelas, suppurative ethmoid back can cause inflammation. can also be spread to the eyes and cause orbital cellulitis whole eye inflammation, and even into the brain causing meningitis has died.
Prevention Daily attention to prevent further evil eye health or disease with anti-virus checks regularly repeated sore eyes and sick tears of pepper and the line of eye disease should be careful to check whether the surgical patients suffering from this disease early detection and timely treatment to avoid too spicy Sunburn Bo, which are spicy foods, especially those suffering from eye diseases prime should pay more attention so as not to cause stomach heat simmers a timely and thorough treatment of eye disease trachoma blepharitis extrinsic ocular inflammation do not give bacteria an opportunity to exploit a deviated nasal septum or inferior turbinate hypertrophy, chronic rhinitis should be the prevention of neonatal early treatment of neonatal dacryocystitis is a relatively common external eye diseases, caused by the blockage of the nasolacrimal duct, usually newborns at the exit of the nasolacrimal duct has a membrane-like closed, most of the new children in the production of tears at the same time it will automatically rupture of membrane (usually 3-4 weeks after birth, tears began to flow channel, but a few thick membrane-like neonatal closed, or due to the Ministry of congenital nasolacrimal duct stenosis or septal deformity, causing lacrimal duct obstruction, retention will be tears in the lacrimal sac, the tears threaten the temperature most suitable for bacterial growth and reproduction, once infected, the tears that turned into pus. When this happens, parents should be a day In the eyes of a child suffering from the nose down on the side of the lacrimal sac area in order to moderate massage, massage with the thumb close to the skin force for the area of ??subcutaneous tears scared to make a top-down slide and massage this massage 2-4 times a day for the same time, points should be used with antibiotics, eye drops (such as rifampin, 3-4 times a day, 1-2 drops each time point. drops of syrup before the application of a cotton swab to wipe the pus clean, such as massage is not effective, you can also make an ophthalmologist for the child to the hospital repeatedly duct flush, if not effective, it should be as early as possible lacrimal duct probing, or they may cause inflammation of the lacrimal sac surrounding tissue, or the formation of tears pouch fistula, which is a extremely difficult to completely cure the fistula, but also affect the appearance of appearance. 
Drug therapy Remove the lacrimal sac infection focus, the establishment of nasal drainage channel, is still the basic principles of modern treatment.
Antibiotic eye drops 1 local drug treatment with a variety of antibiotic eye drops, 3 to 4 times / d, Dropping emptying lacrimal secretions before extrusion, liquid can be sucked into the lacrimal sac, the whole body with sulfonamides or antibiotics, after a period of treatment, purulent secretions can disappear, but can not lift the block and retention, which can only serve as preparation before surgery. 2. lacrimal order to completely remove purulent or mucous secretions, enhancing drug efficacy, can be washed with normal saline lacrimal sac pus rinse, and then injected into the 0.3 ~ 0.5ml of antibiotics. with antibiotics and corticosteroids washing solvent mixture of cellulose, its role can be anti-infective, anti-inflammatory, softening adhesions, there is no fixed shape for the early blocking scar can have a good effect.
Expansion of lacrimal probe surgery Lacrimal probe expanded after the treatment surgery, rinse without purulent secretions, patients can also try to expand exploration and ephedrine nasal drops with antibiotic solution for membrane obstruction or fibrin obstruction is expected to be effective. Probing 2 3 times with no response, surgery should be considered.
Drug treatment  [treatment] 1. Probing and expansion: After a period of washing, to be used only when the discharge disappeared, but disable the violence, to prevent the formation of false passage, so that the spread of infection, leading to increase its congestion level 2. Ground drops medicine: antibiotic eye drops frequency of the risk of eye drops, but should first clean and squeeze the pus sac 3. Lacrimal: with normal saline or antibiotics, hormone or enzyme suppressing agents (such as @ - chymotrypsin rinse 4. Surgical treatment: The dacryocystorhinostomy main lacrimal sac can be removed should be selected depending on the circumstances of its indications such as atrophic rhinitis, lupus, tuberculosis, syphilis, lacrimal sac or ethmoid sinus tissue inflammation around the suppurative inflammation, cancer, corneal inflammation, endophthalmitis, eye trauma should first consider the removal of the lacrimal sac to achieve security. tears nasolacrimal duct obstruction small duct anastomosis was poor, such as a simple mucocele, should nasolacrimal duct anastomosis to the principle. in addition to threading technique.