A 55-year-old woman with chronic sinusitis presents with a palpable swelling in the medial canthal area that has been present for 3 months and is not tender. Pressure over the swelling expresses mucus from the lower punctum. CT shows a dilated lacrimal sac and dacryolithiasis. The definitive surgical treatment is:
- A Repeated probing and syringing of the nasolacrimal duct
- B Jones tube insertion (conjunctivodacryocystorhinostomy)
- C Punctal dilation and silicon tube intubation of the NLD
- D Dacryocystorhinostomy (DCR) creating a new drainage ostium directly from the lacrimal sac to the nasal cavity ✓
Explanation
Chronic dacryocystitis (lacrimal sac infection or mucocoele) due to nasolacrimal duct obstruction with dacryolithiasis requires dacryocystorhinostomy (DCR)—creating a bony communication (rhinostomy) between the lacrimal sac and the nasal cavity, bypassing the obstructed nasolacrimal duct. This can be performed externally (through a skin incision) or endonasally (endoscopic DCR). Endonasal DCR avoids the skin scar and has equal or superior success rates (> 90%). Probing is ineffective for chronic dacryocystitis in adults with a distended sac. Jones tube is reserved for canalicular obstruction, not NLD obstruction.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.