da c rio cystitis
TRANSCRIPT
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Z A L D I
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARAMEDAN
2013
DACRYOCISTITIS
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Dengan menyebut nama Allah
Yang Maha Pengasih Maha Penyayang.
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I. TUJUAN INSTRUKSIONAL UMUM
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Setelah Proses Belajar Mengajar mahasiswa
mampu menegakkan diagnosa dakriosistitisdengan melakukan anamnese dan
pemeriksaan sederhana yang akan dipelajari
selama masa perkuliahan dengan baik danbenar .
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II. TUJUAN INSTRUKSIONAL KHUSUS
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Setelah Proses Belajar Mengajar mahasiswa
mampu mengetahui tanda dan gejala , faktorresiko, prinsip pengobatan, komplikasi, dan
mengkonsulkan secara garis besar dengan
baik dan benar kasus-kasus dakriosistitissesuai dengan kompetensinya
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PATOGENESIS
It follows stasis of secretions in the lacrimal sac due tocongenital blockage in the nasolacrimal duct. It is ofvery common occurrence. As many as 30 percent ofnewborn infants are believed to have closure of
nasolacrimal duct at birth; mostly due to membranousocclusion at its lower end, near the valve of Hasner.
Other causes of congenital NLD blockare: presence ofepithelial debris, membranous occlusion at its upperend near lacrimal sac, complete non-canalisation andrarely bony occlusion. Common bacteria associatedwith congenital dacryocystitis are staphylococci,pneumococci and streptococci.
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CLINICAL PICTURE
Congenital dacryocystitis usually presents as amild grade chronic inflammation. It ischaracterised by:
1. Epiphora, usually developing after seven days ofbirth. It is followed by copious mucopurulentdischarge from the eyes.
2. Regurgitation test is usually positive, i.e., whenpressure is applied over the lacrimal sac area,purulent discharge regurgitates from the lowerpunctum.
3. Swelling on the sac area may appear eventually
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DIFFERENTIAL DIAGNOSIS
Congenital dacryocystitis needs to be
differentiated from other causes of watering in
early childhood especially ophthalmia
neonatorum and congenital glaucoma.
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COMPLICATIONS
Recurrent conjunctivitis,
Acute on chronic dacryocystitis,
Lacrimal abscess
Fistulae formation
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TREATMENT
1. Massage over the lacrimal sac area and topical
antibiotics constitute the treatment of congenital
NLD block, up to 6-8 weeks of age.
Massage increases the hydrostatic pressure in thesac and helps to open up the membranousocclusions.
It should be carried out at least 4 times a day to
be followed by instillation of antibiotic drops. Thisconservative treatment cures obstruction in about90 percent of the infants
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3. Probing of NLD with Bowmans probe. Itshould be performed, in case the condition isnot cured by the age of 3-4 months. Somesurgeons prefer to wait till the age of 6 months.It is usually performed under generalanaesthesia. While performing probing, caremust be taken not to injure the canaliculus. Inmost instances a single probing will relieve theobstruction. In case of failure, it may berepeated after an interval of 3-4 weeks.
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ADULT DACRYOCYSTITIS
CHRONIC DACRYOCYSTITIS
Chronic dacryocystitis is more common than
the acute dacryocystitis.
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ETIOLOGY
The etiological factors can be grouped as under:
A.Predisposing factors
1. Age. It is more common between 40 and 60 years of age.
2. Sex. The disease is predominantly seen in females (80%)probably due to comparatively narrow lumen of the bony canal.
3. Race. It is rarer among Negroes than in Whites; as in the formerNLD is shorter, wider and less sinuous.
4. Heredity.It plays an indirect role. It affects the facial configurationand so also the length and width of the bony canal.
5. Socio-economic status. It is more common in low socio-economic
group.6. Poor personal hygiene. It is also an important predisposing factor
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B.Factors responsible for stasis of tears in
lacrimal sac
1. Anatomical factors, which retard drainage of
tears include: comparatively narrow bonycanal, partial canalization of membranous NLD
and excessive membranous folds in NLD
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2. Foreign bodies in the sac may block opening ofNLD.
3. Excessive lacrimation, primary or reflex, causesstagnation of tears in the sac.
4. Mild grade inflammation of lacrimal sac due toassociated recurrent conjunctivitis may block the NLDby epithelial debris and mucus plugs.
5. Obstruction of lower end of the NLD by nasal
diseases such as polyps, hypertrophied inferiorconcha, marked degree of deviated nasal septum,tumours and atrophic rhinitis causing stenosis mayalso cause stagnation of tears in the lacrimal sac.
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COMPLICATIONS
Chronic intractable conjunctivitis, acute on
chronic dacryocystitis.
Ectropion of lower lid,
Maceration and eczema of lower lid skin dueto prolonged watering.
Simple corneal abrasions may become
infected leading to hypopyon ulcer. Endophthalmitis.
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TREATMENT
1. Conservative treatment by repeated lacrimal
syringing. It may be useful in recent cases
only. Long-standing cases are almost always
associated with blockage of NLD which usuallydoes not open up with repeated lacrimal
syringing or even probing.
2. Dacryocystorhinostomy (DCR).
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ACUTE DACRYOCYSTITIS
Acute dacryocystitis is an acute suppurative
inflammation of the lacrimal sac, characterised
bypresence of a painful swelling in the region
of sac.
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ACUTE DACRYOCICTITIS
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LACRIMAL MUCOCELE
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FISTULA
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ETIOLOGY
It may develop in two ways:
1. As an acute exacerbation of chronic dacryo-cystitits.
2. As an acute peridacryocystitis due to direct
involvement from the neighbouring infected structuressuch as: paranasal sinuses, surrounding bones anddental abscess or caries teeth in the upper jaw.
Causative organisms. Commonly involved are
Streptococcus haemolyticus, Pneumococcus and
Staphylococcus.
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CLINICAL PICTURE
Divided into 3 stages:
1. Stage of cellulitis.
2. Stage of lacrimal abscess.
3. Stage of fistula formation.
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COMPLICATIONS
Acute conjunctivitis,
Corneal abrasion
Lid abscess,
Osteomyelitis of lacrimal bone, Orbital cellulitis,
Facial cellulitis and acute ethmoiditis.
Rarely cavernous sinus thrombosis and very rarely generalized septicaemia may also
develop
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TREATMENT
1. During cellulitis stage. It consists of systemic
and topical antibiotics to control infection; and
systemic anti-inflammatory analgesic drugs
and hot fomentation to relieve pain andswelling.
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REFERENCES
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American Academy of Ophthalmology, External
Disease and Cornea, Section 8, 2011-2012
Khurana AK, Comprehensive Ophthalmology, Fourth
Edition , New Delhi, New Age Internasional (p) LimitedPublisher, 2007.
Vaughan & Asbury's : General Ophthalmology
17th Edition , Mc Graw- Hills Companies , May 2007
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Segala puji bagi Allah, Tuhan semesta alam.