Differential diagnosis

❖ Hordeolum (small, circumscribed, nonmobile inflamed swelling).

❖ Orbital cellulitis (usually associated with reduced motility of the eyeball).

Treatment: Acute cases are treated with local and systemic antibiotics according to the specific pathogens detected. Disinfectant compresses (such as a 1: 1000 Rivanol solution) can also positively influence the clinical course of the disorder. Pus from a fluctuating abscess is best drained through a stab incision following cryoanesthesia with a refrigerant spray.

Treatment after acute symptoms have subsided often requires surgery (dacryocystorhinostomy; Figs. 3.10a-c) to achieve persistent relief. Also known as a lower system bypass, this operation involves opening the lateral wall of the nose and bypassing the nasolacrimal duct to create a direct connection between the lacrimal sac and the nasal mucosa.

Dacryocystorhinostomy.

Dacryocystorhinostomy.

Figs. 3.10a-c A skin incision is made, and the orbital rim is exposed. Then a window is opened to expose the nasal mucosa. The nasal mucosa and the lacrimal sac are both incised in an H-shape and door-like flaps are raised. The anterior and posterior mucosal flaps are then sutured together. This creates a new drainage route for the tear fluid that bypasses the nasolacrimal duct.

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