Page 127 - NAME OF CONDITION: REFRACTIVE ERRORS

 Chronic dacryocystitis associated with suspected dacryolithiasis.
 Chronic dacryocystitis where there is a suspicion of a lacrimal sac tumor.

*Situation 2: At Super Specialty Facility in Metro location where
higher-end technology is available

a) Clinical Diagnosis:
Apart from the regular history taking, care should be exercised to fully understand

the treatment history of the patient, including all the medications along with the
dosage schedules which were prescribed at the secondary centre. In fact, withdrawal
of strong topical antibiotics may be warranted. A fresh comprehensive clinical
examination, as detailed in the previous section should be performed without being
biased by the referral report.

DIAGNOSTIC NASAL ENDOSCOPY:

Nasal examination especially nasal endoscopy is obligatory for every lacrimal patient.
An endocsopy provides a clear diagnostic looks for nasal anatomical variations,
nasal polyps, deviated nasal septum or tumors of the lacrimal sac. It is a very
important for clinical evaluation in postoperative patients and after failed lacrimal
surgery. The procedures are performed through rigid or flexible 2.7mm or 4mm
endoscopes.

STANDARD PROCEDURE

1. Nasal mucosa is decongested and anesthetized with topical medications.

2. The patient either sits or lies in a relaxed position.

3. Nasal vestibule, inferior meatus, floor of the nose and nasopharynx are examined.

4. Middle turbinates and meatus is examined and then the scope is directed postero-
superiorly to evaluate the spheno-ethmoidal recess and superior meatus.

b) Investigation
As the patients are referred from a secondary centre for a non responsiveness to
treatment or when diagnosis is additional microbiological and imaging studies may
be required.

 Culture: Culture and sensitivity of the discharge is indicated specially in cases

of orbital cellulitis or recurrent lacrimal abscess. When performed, collect
discharge with a calcium alginate swab moistened with saline. Apart from
smears for grams and giemsa staining, culture onto blood and chocolate agar is

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