Dacryocystitis

Background

Right eye lacrimal system consisting of: of lacrimal gland (a), punctums (b,e), canalicules (c,f), lacrimal sac (g,d).

• 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

Left sided dacryocystitis

Bilateral dacryocystitis

• 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

• Periorbital swelling

External Links

https://eyewiki.aao.org/Dacryocystitis