What is the initial management of Congenital dacrocystitis?
ANSWER: (A) MassageREF: Khurana 4th Ed Pg 369TREATMENT OF CONGENITAL DACROCYSTITIS:It depends upon the age at which the child is brought. The treatment modalities employed are as follows: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 the sac and helps to open up the membranous occlusions. It should be carried out at least 4 times a day to be followed by instillation of antibiotic drops. This conservative treatment cures obstruction in about 90 percent of the infants.Lacrimal syringing (irrigation) with normal saline and antibiotic solution. It should be added to the conservative treatment if the condition is not cured up to the age of 2 months. Lacrimal irrigation helps to open the membranous occlusion by exerting hydraulic pressure. Syringing may be carried out once or twice a week.Probing of NLD with Bowman's probe. It should be performed, in case the condition is not cured by the age of 3-4 months. Some surgeons prefer to wait till the age of 6 months. It is usually performed under general anaesthesia. While performing probing, care must be taken not to injure the canaliculus. In most instances a single probing will relieve the obstruction. In case of failure, it may be repeated after an interval of 3- 4 weeks.Intubations with silicone tube may be performed if repeated probings are failure. The silicone tube should be kept in the NLD for about six months.Dacryocystorhinostomy (DCR) operations: When the child is brought very late or repeated probing is a failure, then conservative treatment by massaging, topical antibiotics and intermittent lacrimal syringing should be continued till the age of 4 years. After this, DCR operation should be performed.
Massage
Lacrimal syringing
Dacryocystorhinostomy
Antibiotics
Lacrimal Gland