CASE STUDY Heather has been referred to the ophthalmic surgeon because her sympt
ID: 3511859 • Letter: C
Question
CASE STUDY Heather has been referred to the ophthalmic surgeon because her symptoms have not improved after several weeks of more conservative treatment. She has been suffering pain in her left eye, and the area beneath her eye and next to her nose is red painful, and inflamed. The area is sensitive to touch, and for several days a discharge has been present on the nasal side of the eye. 1. What must have been the diagnosis that caused the patient's doctor to refer her to a surgeon? 2. What will be the most probable surgical intervention? 3. What special anesthesia needs directly related to the particular surgical procedure will need to be met?Explanation / Answer
1. This is a typical case of Dacryocystitis. His eye is red near the nose and also the nose is red. This is the place where lacrimal duct opens into lacrimal sac. Any obstruction here will stop the drainage of tear system and will cause infection at the region. All the symptoms coincide with diagnosis of dacryocystitis.
2. If conservative medical treatment(topical and sytemic antibiotic therapy with eye care) fails then the surgical therapy is the option. In surgical treatment the obstruction in the juction of lacrimal duct with lacrimal sac is done using laser, known as Dacryocystorhinostomy. If dacryocystorhinostomy is not possible or there is chronic dacryocystitis even after dacryorhinostomy, then Dacryocystectomy or removal of lacrimal sac is done and lacrimal ducts are freely open into nasal cavity.
3. Bleeding is the main problem in dacryocstorhinostomy and in dacryocystectomy. So in the past when general anethesia was give , hypotensive anesthesia were used to reduced the intra-operative bleeding. Also nasal pack and throat pack need to be give to prevent aspiration of blood into lung during operation, so intubation was a must during operation. Lidocain/epinephrine with nasal decongestant pack was given incision to keep the operative area under clear visualization. Nowadays regional anesthesis is used to block infratrochlear, infraorbital and anterior ethmoidal nerves. But intubation is till a safety measure to prevent blood aspiration. Regional anesthesi is more effectiv ein cotrolling bleeding with decreased hospital stay.
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