Treatment of choice for the chronic dacrocystitis:

Ans. (d) DacrocystorhinostomyRef.: A.K. Khurana 6th ed. /395-96Dacrocystits is inflammation of the lacrimal sac# CHRONIC PACROCYSTITIS* Chronic dacryocystitis is more common than the acute dacrocystitis.* Cause: Vicious cycle of stasis and mild infection of long duration.* Factors responsible for stasis of tears in lacrimal sac:# Anatomical factors: Narrow bony canal# Foreign bodies in the sac may block opening of NLD.# Excessive lacrimation# Mild grade inflammation: May block the NLD# Obstruction of lower end of the NLD by nasal diseses such as polyps, hypertrophied inferior concha, severe deviated nasal septum.* Source of infection: It may get infected from the conjunctiva, nasal cavity (retrograde spread), or paranasal sinuses by: Staphylococci, pneumococci, streptococci and pseudomonas pyocyanea.* Clinical Feature# Stage of chronic catarrhal dacryocystitis:Characterised by mild inflammation of the lacrimal sac associated with blockage of NLD.# Stage of lacrimal mucocoele: Characterized by constant epiphora associated with a swelling just below the inner canthus.# Stage of chronic suppurative dacryocystitis:Characterized by epiphora, associated recurrent conjunctivitis and swelling at the inner canthus with mild erythema.# Stage of chronic fibrotic sac: repeated infections may result in a small fibrotic sac due to thickening of mucosa, which is associated with epiphora and discharge.* Treatment# Conservative treatment by repeated lacrimal syringing.# Dacryocystorhinostomy (DCR). It is considered as surgery of choice as it re-establishes the lacrimal drainage.# Dacryocystectomy (DCT). It should be performed only when DCR is contraindicated.# Conjunctivodacryocystorhinostomy (CDCR). It is performed in the presence of blocked canaliculi.