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Dental-related epiphora and dacryocystitis
/content/chapter/10.22233/9781910443163.chap28
Dental-related epiphora and dacryocystitis
- Author: Richard Saunders
- From: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging
- Item: Chapter 28, pp 382 - 394
- DOI: 10.22233/9781910443163.28
- Copyright: © 2013 British Small Animal Veterinary Association
- Publication Date: January 2013
Abstract
Knowledge of the normal anatomy of the nasolacrimal duct, and the structures through which it travels, is required to investigate and treat rabbits with epiphora, dacryocystitis and chronic nasal discharge. This chapter observes anatomy of the nasolacrimal duct and related structures; aetiopathogenesis; diagnosis; medical treatment; dental treatment; surgical treatment; and prognosis. Quick Reference Guides/Techniques: Flushing the nasolacrimal duct; Marsupialization of the lacrimal sac.
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Figures
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28.1
The single ventral lacrimal punctum, with an intravenous catheter entering it. © 2013 British Small Animal Veterinary Association
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28.1
The single ventral lacrimal punctum, with an intravenous catheter entering it.
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28.2
The bony lacrimal canal, through which the nasolacrimal duct is visible on this plain lateral radiograph (white arrow). © 2013 British Small Animal Veterinary Association
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28.2
The bony lacrimal canal, through which the nasolacrimal duct is visible on this plain lateral radiograph (white arrow).
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28.3
The facial dermatitis shown by this rabbit is due to tear overflow on to the fur and skin. (Courtesy of Frances Harcourt-Brown) © 2013 British Small Animal Veterinary Association
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28.3
The facial dermatitis shown by this rabbit is due to tear overflow on to the fur and skin. (Courtesy of Frances Harcourt-Brown)
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28.4
Mutual grooming is a part of the rabbit’s social behaviour. (Courtesy of ME Buseth) © 2013 British Small Animal Veterinary Association
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28.4
Mutual grooming is a part of the rabbit’s social behaviour. (Courtesy of ME Buseth)
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28.5
Severe keratoconjunctivitis, blepharitis and periorbital dermatitis secondary to dacryocystitis. (Courtesy of L Duckworth) © 2013 British Small Animal Veterinary Association
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28.5
Severe keratoconjunctivitis, blepharitis and periorbital dermatitis secondary to dacryocystitis. (Courtesy of L Duckworth)
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28.6
Positive-contrast lateral dacryocystograph showing the normal nasolacrimal duct. © 2013 British Small Animal Veterinary Association
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28.6
Positive-contrast lateral dacryocystograph showing the normal nasolacrimal duct.
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28.7
Positive-contrast study of a rabbit with dacryocystitis affecting the right eye. (a) On this lateral view, the nasolacrimal duct is filled with aqueous positive contrast medium (iohexol), showing that the nasal section of the duct has ruptured into the maxillary sinus (white arrow). There is pathology and apical elongation of the 1st incisor, which is distorting the maxillary bone and occluding the nasolacrimal duct. The tooth has no enamel or pulp cavity (yellow arrow). There is also deformity and apical elongation of the cheek teeth. (b) Dorsoventral view of the same rabbit. Iohexol had also been instilled into the left nasolacrimal duct, which was not obstructed. A thin line of contrast material can be seen in the nasal section of the duct. (Courtesy of Frances Harcourt-Brown) (Image reproduced from In Practice, with permission) © 2013 British Small Animal Veterinary Association
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28.7
Positive-contrast study of a rabbit with dacryocystitis affecting the right eye. (a) On this lateral view, the nasolacrimal duct is filled with aqueous positive contrast medium (iohexol), showing that the nasal section of the duct has ruptured into the maxillary sinus (white arrow). There is pathology and apical elongation of the 1st incisor, which is distorting the maxillary bone and occluding the nasolacrimal duct. The tooth has no enamel or pulp cavity (yellow arrow). There is also deformity and apical elongation of the cheek teeth. (b) Dorsoventral view of the same rabbit. Iohexol had also been instilled into the left nasolacrimal duct, which was not obstructed. A thin line of contrast material can be seen in the nasal section of the duct. (Courtesy of Frances Harcourt-Brown) (Image reproduced from In Practice, with permission)
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28.8
This contrast CT series shows three views (from top to bottom: sagittal, coronal, transverse) of the left nasolacrimal duct. The orange arrows mark the duct, filled with water-based contrast material. (Courtesy of Laura Crews) © 2013 British Small Animal Veterinary Association
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28.8
This contrast CT series shows three views (from top to bottom: sagittal, coronal, transverse) of the left nasolacrimal duct. The orange arrows mark the duct, filled with water-based contrast material. (Courtesy of Laura Crews)
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28.9
MRI scan (coronal plane) of a rabbit skull. There is severe rhinitis, sinusitis and associated bone lysis and dacryocystitis on the worst affected side (R). © 2013 British Small Animal Veterinary Association
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28.9
MRI scan (coronal plane) of a rabbit skull. There is severe rhinitis, sinusitis and associated bone lysis and dacryocystitis on the worst affected side (R).
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28.10
(a) Before treatment, there is significant purulent discharge from both ends of the nasolacrimal duct. (b) After systemic antibiotic treatment, mild epiphora remains. © 2013 British Small Animal Veterinary Association
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28.10
(a) Before treatment, there is significant purulent discharge from both ends of the nasolacrimal duct. (b) After systemic antibiotic treatment, mild epiphora remains.
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28.11
Erosion of the maxilla and spontaneous rupture of the nasolacrimal duct. (a) Prepared maxilla of a rabbit with advanced dental disease. The elongated apex of the incisor has curved towards the nasal passages and penetrated the bone (arrow). The site of this lesion can be seen in (b), a dacryocystogram of a nasolacrimal duct blocked by an elongated curved incisor that has not penetrated the bone. Penetration of the bone and diversion on lacrimal fluid into the nasal cavity can be seen in (c), a dacryocystogram of an anaesthetized rabbit with severe dacrocystitis. The iohexol has bypassed the distal section of the nasolacrimal duct, and can be seen in the nasal cavity; this improved drainage assisted in resolution of the clinical signs. (Courtesy of Frances Harcourt-Brown; (b) reproduced from In Practice, with permission) © 2013 British Small Animal Veterinary Association
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28.11
Erosion of the maxilla and spontaneous rupture of the nasolacrimal duct. (a) Prepared maxilla of a rabbit with advanced dental disease. The elongated apex of the incisor has curved towards the nasal passages and penetrated the bone (arrow). The site of this lesion can be seen in (b), a dacryocystogram of a nasolacrimal duct blocked by an elongated curved incisor that has not penetrated the bone. Penetration of the bone and diversion on lacrimal fluid into the nasal cavity can be seen in (c), a dacryocystogram of an anaesthetized rabbit with severe dacrocystitis. The iohexol has bypassed the distal section of the nasolacrimal duct, and can be seen in the nasal cavity; this improved drainage assisted in resolution of the clinical signs. (Courtesy of Frances Harcourt-Brown; (b) reproduced from In Practice, with permission)
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The punctum is identified in the ventral eyelid.
The punctum is identified in the ventral eyelid. © 2013 British Small Animal Veterinary Association
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The punctum is identified in the ventral eyelid.
The punctum is identified in the ventral eyelid.
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A suitable cannula is inserted into the punctum.
A suitable cannula is inserted into the punctum. © 2013 British Small Animal Veterinary Association
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A suitable cannula is inserted into the punctum.
A suitable cannula is inserted into the punctum.
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Sterile fluid is passed through the cannula and nasolacrimal duct until it flows freely.
Sterile fluid is passed through the cannula and nasolacrimal duct until it flows freely. © 2013 British Small Animal Veterinary Association
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Sterile fluid is passed through the cannula and nasolacrimal duct until it flows freely.
Sterile fluid is passed through the cannula and nasolacrimal duct until it flows freely.
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Applying digital pressure to the swelling will squeeze copious amounts of purulent secretion through the lacrimal punctum into the conjunctival sac.
Applying digital pressure to the swelling will squeeze copious amounts of purulent secretion through the lacrimal punctum into the conjunctival sac. © 2013 British Small Animal Veterinary Association
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Applying digital pressure to the swelling will squeeze copious amounts of purulent secretion through the lacrimal punctum into the conjunctival sac.
Applying digital pressure to the swelling will squeeze copious amounts of purulent secretion through the lacrimal punctum into the conjunctival sac.
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Constant contact with pus can result in a painful keratoconjunctivitis.
Constant contact with pus can result in a painful keratoconjunctivitis. © 2013 British Small Animal Veterinary Association
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Constant contact with pus can result in a painful keratoconjunctivitis.
Constant contact with pus can result in a painful keratoconjunctivitis.
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Lateral skull radiograph of a rabbit with a profuse unilateral ocular and nasal discharge and a palpably dilated lacrimal sac. There is radiopacity of the maxillary sinus and a fractured maxillary incisor (arrow). The root was infected and obstructing the nasolacrimal duct.
Lateral skull radiograph of a rabbit with a profuse unilateral ocular and nasal discharge and a palpably dilated lacrimal sac. There is radiopacity of the maxillary sinus and a fractured maxillary incisor (arrow). The root was infected and obstructing the nasolacrimal duct. © 2013 British Small Animal Veterinary Association
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Lateral skull radiograph of a rabbit with a profuse unilateral ocular and nasal discharge and a palpably dilated lacrimal sac. There is radiopacity of the maxillary sinus and a fractured maxillary incisor (arrow). The root was infected and obstructing the nasolacrimal duct.
Lateral skull radiograph of a rabbit with a profuse unilateral ocular and nasal discharge and a palpably dilated lacrimal sac. There is radiopacity of the maxillary sinus and a fractured maxillary incisor (arrow). The root was infected and obstructing the nasolacrimal duct.
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Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2013 British Small Animal Veterinary Association
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Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2013 British Small Animal Veterinary Association
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Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Post-mortem dissection to show the position of the lacrimal sac.
Post-mortem dissection to show the position of the lacrimal sac. © 2013 British Small Animal Veterinary Association
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Post-mortem dissection to show the position of the lacrimal sac.
Post-mortem dissection to show the position of the lacrimal sac.
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Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2013 British Small Animal Veterinary Association
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Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Vertical view of lacrimal sac after removal of tented wall.
Vertical view of lacrimal sac after removal of tented wall. © 2013 British Small Animal Veterinary Association
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Vertical view of lacrimal sac after removal of tented wall.
Vertical view of lacrimal sac after removal of tented wall.
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Lateral aspect of lacrimal sac to show resected section.
Lateral aspect of lacrimal sac to show resected section. © 2013 British Small Animal Veterinary Association
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Lateral aspect of lacrimal sac to show resected section.
Lateral aspect of lacrimal sac to show resected section.
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Postoperative appearance immediately after marsupialization.
Postoperative appearance immediately after marsupialization. © 2013 British Small Animal Veterinary Association
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Postoperative appearance immediately after marsupialization.
Postoperative appearance immediately after marsupialization.
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Same rabbit as above, 5 days postoperatively.
Same rabbit as above, 5 days postoperatively. © 2013 British Small Animal Veterinary Association
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Same rabbit as above, 5 days postoperatively.
Same rabbit as above, 5 days postoperatively.
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In some cases where infection is still present in the lacrimal duct, a fistula may form beneath the medial canthus. A cannula can be inserted to flush material through the duct and out of the nose.
In some cases where infection is still present in the lacrimal duct, a fistula may form beneath the medial canthus. A cannula can be inserted to flush material through the duct and out of the nose. © 2013 British Small Animal Veterinary Association
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In some cases where infection is still present in the lacrimal duct, a fistula may form beneath the medial canthus. A cannula can be inserted to flush material through the duct and out of the nose.
In some cases where infection is still present in the lacrimal duct, a fistula may form beneath the medial canthus. A cannula can be inserted to flush material through the duct and out of the nose.