A 40-year-old woman presents with chronic watery eye (epiphora) and recurrent episodes of mucopurulent discharge from the medial canthus. Regurgitation of mucopus on pressure over the lacrimal sac (positive regurgitation test) is noted. The nasolacrimal duct is found to be blocked. The definitive surgical treatment is:

• A Dacryocystorhinostomy (DCR) ✓
• B Punctal dilation and syringing
• C Canaliculotomy
• D Dacryocystectomy

Explanation

Chronic dacryocystitis results from obstruction of the nasolacrimal duct causing stasis of secretions and secondary infection of the lacrimal sac. Dacryocystorhinostomy (DCR) is the definitive surgical treatment: it creates a new drainage pathway between the lacrimal sac and the nasal cavity (middle meatus), bypassing the obstructed nasolacrimal duct. It can be performed externally (higher success rate ~90%) or endoscopically. Dacryocystectomy (excision of the sac) is reserved for malignant lesions or failed DCR.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.