Dacrocystitis in a Teenager?
Discussion Tears are produced in the lacrimal gland which resides in the upper outer quadrant of the eye. The tears flow across the eye medially and are collected in the superior and inferior puncta which drain into their respective canaliculi, and these drain into a common canaliculus. Tears then pass through the valve of Rosenmuler into the lacrimal sac where they are collected. Tears then pass through the nasolacrimal duct, through the distal valve of Hasner and into the nasal cavity. Vascular connections are extensive in this anatomic area and veins do not have valves. Therefore infections can spread easily through direct or indirect spread from the nasolacrimal duct system to other adjacent systems. Dacrocystitis is an inflammation of the nasolacrimal sac that is usually caused by obstruction, leading to tear stagnation which then provides a good environment for proteinaceous material to form and infectious organisms to propagate. Dacrocystitis can be acute or congenital or acquired and acute or chronic. Congenital dacrocystitis is usually due to obstruction or stenosis in the distal anatomy particular the valve of Hasner. “Before delivery [of an infant] the nasolacrimal system is filled with amniotic fluid. When the amniotic fluid fails to be expressed forom the nasolacrimal system, it becomes purulent with a few days of delivery and becomes pathologic.” Acquired disease is caused by trauma, surgery, foreign bodies, neoplasms or medications. Chronic disease ...
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