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Quick Review #132 - #dacrocystitis #ophtho #ophthalmology #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon

Dacryocystitis is an inflammation or infection of the lacrimal sac, which is a part of the tear drainage system of the eye. The condition can be either acute or chronic and can affect individuals of any age, though it's more common in infants and adults over 40 years of age.

Signs & Symptoms:

Acute Dacryocystitis

- Pain: Often severe and localized to the inner corner of the eye.

- Redness: In the affected area.

- Swelling: Over the lacrimal sac.

- Tearing: Excessive tearing (epiphora).

- Discharge: Sometimes a purulent discharge.

- Fever: In some cases.

Chronic Dacryocystitis

- Chronic Tearing: Persistent epiphora.

- Discharge: Mucopurulent discharge, especially with pressure over the lacrimal sac.

- Minimal Pain: Usually less painful than acute dacryocystitis.

- Swelling: Can be present but is typically less pronounced.

Causes:

Dacryocystitis often occurs when the tear drainage system becomes blocked or narrowed. The blockage can lead to bacterial infection. Common causes include:

1. Nasolacrimal Duct Obstruction: The most common cause, which can be congenital or acquired.

2. Trauma: Injury to the nasal or orbital area.

3. Nasal Issues: Deviated septum, nasal polyps, or sinusitis.

4. Foreign Body: Such as stones (dacryoliths) or other materials blocking the duct.

5. Systemic Conditions: Such as sarcoidosis, granulomatosis with polyangiitis, or other inflammatory conditions.

Treatment:

Acute Dacryocystitis

- Antibiotics: Oral or intravenous antibiotics, depending on the severity. Common choices include cephalexin, amoxicillin-clavulanate, or clindamycin.

- Warm Compresses: Applied to the affected area.

- Pain Management: Analgesics for pain relief.

- Surgical Drainage: If an abscess forms, surgical drainage may be necessary.

Chronic Dacryocystitis

- Dacryocystorhinostomy (DCR): A surgical procedure to create a new tear drain between the lacrimal sac and the nasal cavity, bypassing the blocked duct. This is often the definitive treatment.

- Antibiotics: May be used if there is an active infection.

- Stenting: Sometimes a stent or tube is placed in the duct to help keep it open after surgery.

References:

1. Rowe, C. (2024). Dacryocystitis and Dacryoadenitis [Illustration]. In A. L. Balogun & C. Rowe, StatPearls. StatPearls Publishing. https://lnkd.in/ev6mNQhk

2. 1. Ali, M. J., Naik, M. N., & Honavar, S. G. (2015). Acute Dacryocystitis: Microbiology and Management. Ophthalmic Plastic and Reconstructive Surgery, 31 (2), 177–182. https://lnkd.in/eFw4pgRG

3. Lueder, G. T. (2014). Dacryocystitis in Infants and Children. Pediatric Clinics of North America, 61 (3), 553–562. https://lnkd.in/e7kyJB5n

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