The clinical case report of glaucoma surgery in a patient with obliteration of lacrimal passages
Ermolaev A.P.,Atkova E.L.,
Melnikova L.I., Yartsev V.D.

Scientific Research Institute of Eye Diseases

     The paper presents a clinical case of the urgent glaucoma surgery in patient with lacrimal passages obstruction and high risk of bacterial contamination. In general practice patients with lacrimal passages obliteration first of all need their sanitation in order to reduce the risk of retrograde infection during glaucoma surgery. And the glaucoma surgery itself is postponed. In cases of high intraocular pressure and rapid decline of visual functions glaucoma surgery can not be delayed for a long time Then the cauterization of lacrimal points is used before glaucoma surgery. However, this technique is traumatic and lead to additional risk of further deterioration of lacrimal passages.
     In present case report both lacrimal point of the operated eye were first obturated with special silicone occluders. This procedure eliminated opportunity of retrograde bacterial contamination. Used occluder was a silicone implant, consisting of two extensions and isthmus (0.1 mm). The postoperative period was uncomplicated. The patient received standard treatment after glaucoma surgery and additionally antibiotics instillation to the operated eye with antibiotic change every 10 days. In 2 weeks after operation the repeat sowing was performed. In case of absence of microflora growth, conjunctival sutures can be removed. Occluder was removed 3 weeks after the surgery, when the conjunctival postoperative scar had completely formed. The implant was removed from the lacrimal points under the slit lamp, using tweezers. Instillation of disinfectants was prescribed into conjunctival cavity of operated eye. Later lacrimal passages were treated routinely. Described procedure allows to minimize the risk of intra- and postoperative eye infection and to perform glaucoma surgery in time.

Keywords: glaucoma surgery, obliterating dacryocystitis, lacrimal points, silicone occluders, postoperative eye infection.

For citation: Ermolaev A.P., Atkova E.L., Melnikova L.I., Yartsev V.D.
The clinical case report of glaucoma surgery in a patient with
obliteration of lacrimal passages. // RMJ. Clinical ophthalomology.
2015. № 4. P. 180–183.