Treatment of chronic dacryocystitis from the rhinologist's point of view involves classification of the condition into certain types : (1) infection of the sac with intranasal abnormalities; (2) infection of the sac with involvement of accessory nasal sinuses; (3) infection of the sac without intranasal involvement, and (4) recurrent infection of the sac with or without a fistulous tract or stenosis of the duct. The etiologic factor in these cases is generally a suppurative lesion in the anterior ethmoid cells, and recovery will not occur until the cells are removed surgically, even though total extirpation of the sac has been performed.
The first symptom of dacryocystitis is tearing (epiphora). Later there is suppuration (due to bacteria), which is recognized by expression of pus into the conjunctiva on pressure over the lacrimal sac. The sac may dilate and rupture, or it may be incised, with a remaining fistula. The patency of the