1. Tearing: hyperlacrimation, epiphora

2. Dry eye: tear break-up time, Schirmer test

3. Epiphora: -malpositioning -obst.

4. INFECTIONS OF LACRIMAL PASSAGES
1. Congenital nasolacrimal duct(NLD)obstruction
2. Congenital dacryocele
3. Chronic canaliculitis
4. Dacryocystitis
Acute
Chronic

5. Congenital nasolacrimal duct obstruction
Caused by delayed canalization near valve of Hasner,Common
On pressure reflux of purulent material from punctum
Epiphora and matting
Infrequently acute dacryocystitis

6. Treatment of congenital nasolacrimal
duct obstruction
one third: bilateral
Role out congenital glaucoma
Massage of nasolacrimal duct:10strokes 4 times a day
antibiotic drops 4 times daily: if..discharge
Improvement by age 12 months in 95% of cases
If no improvement - probe at 12 months
Results - 90% cure by first probing
6% by repeated probing

7. Congenital dacryocele
Distension of lacrimal sac by trapped amniotic fluid (amniontocele)
caused by imperforate valve of Hasner
Bluish cystic swelling at or below medial canthal
tendon
May become secondarily infected
Do not mistake for encephalocele
- pulsatile swelling above medial canthal tendon
Treatment
Initially massage
Probing if massage fails

8. Acute dacryocystitis
Usually secondary to nasolacrimal duct obstruction and tear stasis
Tender canthal swelling
Mild preseptal cellulitis
May develop into abscess
Intraosseous obstruction
Treatment
Systemic antibiotics and warm compresses
DCR after acute infection is controlled

9. Chronic dacryocystitis
Epiphora and chronic or recurrent unilateral conjunctivitis
Painless swelling at inner canthus
Expressed mucopurulent material
Treatment - DCR

10. Dacryocystorhinostomy