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
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- 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
References
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