Dacryocystitis: Difference between revisions
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==Background== | ==Background== | ||
*Acute or chronic inflammation and bacterial infection of the lacrimal sac | [[File:Tear system.png|thumb|Right eye lacrimal system consisting of: of lacrimal gland (a), punctums (b,e), canalicules (c,f), lacrimal sac (g,d).]] | ||
**Most common pathogens: | *Acute or chronic inflammation and bacterial infection of the lacrimal sac, often due to obstruction of lacrimal duct | ||
**Most common pathogens: ''[[S. pneumoniae]]'', ''[[S. aureus]]'', ''[[S. epidermidis]]'', ''[[H. influenzae]]'' | |||
*Most common in children | *Most common in children | ||
*Often after viral URI | *Often secondary bacterial infection after viral [[URI]] | ||
*Complications: [[ | *Complications: [[periorbital cellulitis]], [[orbital cellulitis]], [[meningitis]] | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC2908819 kjo-20-65-g001.png|thumb|Left sided dacryocystitis]] | |||
[[File:PMC3339083 IJO-60-155b-g001.png|thumb|Bilateral dacryocystitis]] | |||
*Mucopurulent material expressed from nasolacrimal sac | *Mucopurulent material expressed from nasolacrimal sac | ||
*Erythema and edema between medial canthus and nasal bridge | *Erythema and edema between medial canthus and nasal bridge | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Periorbital swelling DDX}} | {{Periorbital swelling DDX}} | ||
{{Neonatal eye problems DDX}} | |||
==Evaluation== | |||
*Generally a clinical diagnosis | |||
*Consider culture of any purulent drainage- express via gentle upward pressure to affected area | |||
==Management== | |||
*[[Clindamycin]] PO for 7-10 days | |||
*Decongestants | |||
*Warm compress | |||
*If toxic-appearing: IV [[Cephalosporin]] ([[Cefuroxime]] 50mg/kg IV Q8h '''OR''' [[Cefazolin]] 33mg/kg IV Q6H) '''OR''' [[Clindamycin]] (10mg/kg IV Q8H) | |||
**If [[MRSA]] suspected, add [[Vancomycin]] | |||
*Chronic dacryocystitis: topical ([[fluoroquinolone]] or [[erythromycin]]) | |||
==Disposition== | |||
*Generally may be discharged with ophthalmology follow-up | |||
==See Also== | |||
*[[Periorbital swelling]] | |||
== | ==External Links== | ||
https://eyewiki.aao.org/Dacryocystitis | |||
==References== | ==References== | ||
<references/> | |||
Latest revision as of 20:55, 15 January 2021
Background
- Acute or chronic inflammation and bacterial infection of the lacrimal sac, often due to obstruction of lacrimal duct
- Most common pathogens: S. pneumoniae, S. aureus, S. epidermidis, H. influenzae
- Most common in children
- Often secondary bacterial infection after viral URI
- Complications: periorbital cellulitis, orbital cellulitis, meningitis
Clinical Features
- Mucopurulent material expressed from nasolacrimal sac
- Erythema and edema between medial canthus and nasal bridge
Differential Diagnosis
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Neonatal eye problems
- Nasolacrimal duct obstruction
- Dacrocystitis
- Conjunctivitis
- Chemical
- Gonococcal
- Chlamydia
- Herpetic
- Streptococcus/S. Aureus
- Early onset glaucoma
- Uveitis
- Ocular foreign body
- Corneal abrasion
- Ocular trauma
- Ingrown eyelash
Evaluation
- Generally a clinical diagnosis
- Consider culture of any purulent drainage- express via gentle upward pressure to affected area
Management
- Clindamycin PO for 7-10 days
- Decongestants
- Warm compress
- If toxic-appearing: IV Cephalosporin (Cefuroxime 50mg/kg IV Q8h OR Cefazolin 33mg/kg IV Q6H) OR Clindamycin (10mg/kg IV Q8H)
- If MRSA suspected, add Vancomycin
- Chronic dacryocystitis: topical (fluoroquinolone or erythromycin)
Disposition
- Generally may be discharged with ophthalmology follow-up
See Also
External Links
https://eyewiki.aao.org/Dacryocystitis