Differential diagnosis

•:• Gonococcal conjunctivitis and inclusion conjunctivitis (see Fig.4.3). ❖ Silver catarrh (harmless conjunctivitis with slimy mucosal secretion following Crede's method of prophylaxis with silver nitrate).

Treatment: During the first few weeks, the infant should be monitored for spontaneous opening of the stenosis. During this period, antibiotic and anti-inflammatory eyedrops and nose drops (such as erythromycin and xylo-metazoline 0.5% for infants) are administered.

If symptoms persist, irrigation or probing under short-acting general anesthesia may be indicated (see Figs. 3.7a-c).

H Often massaging the region several times daily while carefully applying pressure to the lacrimal sac will be sufficient to open the valve of Hasner and eliminate the obstruction.

This usually involves inflammation of the canaliculus.

Epidemiology and etiology: Genuine canaliculitis is rare. Usually a stricture will be present and the actual inflammation proceeds from the conjunctiva. Actinomycetes (fungoid bacteria) often cause persistent purulent granular concrements that are difficult to express.

Symptoms and diagnostic considerations: The canaliculus region is swollen, reddened, and often tender to palpation. Pus or granular concrements can be expressed.

Treatment: The disorder is treated with antibiotic eyedrops and ointments according to the specific pathogens detected in cytologic smears. Successful treatment occasionally requires surgical incision of the canaliculus.

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