II. Pathophysiology

  1. Nasolacrimal Duct Obstruction
  2. Obstruction predisposes to tear stasis and infection
  3. Bacterial Infection occurs from contiguous spread from colonized Conjunctiva or nasal mucosa
    1. Streptococcus Pneumoniae
    2. Staphylococcus aureus
    3. HaemophilusInfluenzae
    4. Streptococcus Pyogenes
    5. Enterobacteriaceae

III. Types

  1. Acute Dacryocystitis
    1. Presents with pain and erythema at the medial canthus
  2. Chronic dacrocystis
    1. Chronic inflammation at the lacrimal sac results in epiphora
  3. Congenital Dacryocystitis
    1. Distinguish from the typical minor Lacrimal Duct Obstruction common to many newborns (relieved with massage at medial canthus)
    2. Associated with craniofacial abnormalities
    3. Risk of Orbital Cellulitis

IV. Causes

  1. Infants
    1. Congenital Nasolacrimal Duct Obstruction
  2. Adults
    1. Chronic Rhinitis or Chronic Sinusitis
    2. Facial Trauma
    3. Maxillofacial tumor

V. Differential diagnosis

VI. Symptoms

  1. Eye Pain or irritation
  2. Epiphora (excessive tearing, spilling onto the face)

VII. Signs

  1. Acute
    1. Conjunctival injection
    2. Inflammation of the medial portion of lower Eyelid (at medial canthus)
      1. Affects the region of the lacrimal sac
      2. Localized pain, tenderness, swelling and redness
    3. Purulent discharge from the lacrimal puncta
      1. Drainage increases with pressure over the lacrimal sac
  2. Chronic
    1. Pressure on puncta expresses fluid
    2. Conjunctivitis
    3. Blepharitis

VIII. Lab

  1. Exudate culture and Gram Stain (identifies MRSA)

IX. Management: General

  1. Urgent ophthalmology referral (Incision and Drainage may be needed)

X. Management: Antibiotics in children

  1. Mild to moderate cases
    1. Amoxicillin-clavulanate (Augmentin)
  2. Severe cases
    1. Cefuroxime

XI. Management: Antibiotics in adults

  1. Mild to moderate
    1. Cephalexin
  2. Severe cases (2 antibiotic regimens)
    1. Antibiotic 1 (choose one)
      1. Nafcillin or Oxacillin 2 grams IV every 4 hours
      2. Vancomycin 15-20 mg/kg IV every 8-12 hours (if MRSA suspected)
    2. Antibiotic 2 (choose one)
      1. Ceftriaxone 2 g IV every 24 hours
      2. Cefepime 2 g IV every 12 hours
      3. Levofloxacin 750 mg IV or oral every 24 hours (if Cephalosporin allergic)

XII. References

  1. Trobe (2012) Physician's Guide to Eye Care, AAO, San Francisco, p. 62-3
  2. Gilbert (2012) Sanford Guide

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Ontology: Dacryocystitis (C0010930)

Definition (MSHCZE) Zánět slzného vaku. Akutní forma je provázena bolestmi, vyklenutím v blízkosti vnitřního koutku oka. Z dolního slzného bodu lze někdy vytlačit hnis, který může i prosvítat kůží (dacryocystitis phlegmonosa); kultivačně lze prokázat např. stafylokoka, pneumokoka či Haemophilus influenzae; příčinou může být i tuberkulóza. Chronická forma může být charakterizována spíše hlenovou či mukopurulentní sekrecí. D. může být i vrozená (dacryocystitis congenita). Léčí se antibiotiky, obklady a výjimečně incizí (dakryocystotomie) zaníceného vaku. Zánět je spojen s neprůchodností ductus nasolacrimalis, proto se po odeznění akutní fáze někdy provádí dakryocystorinostomie. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Inflammation of the lacrimal sac. (Dorland, 27th ed)
Concepts Disease or Syndrome (T047)
MSH D003607
ICD9 375.30
ICD10 H04.30
SnomedCT 193989000, 267738004, 193987003, 155183008, 85777005
English Dacryocystitides, Dacryocystitis, Dacryocystitis NOS, Dacryocystitis, unspecified, dacryocystitis (diagnosis), dacryocystitis, Unspecified dacryocystitis, Dacryocystitis [Disease/Finding], dacrocystitis, Dacryocystitis NOS (disorder), Unspecified dacryocystitis (disorder), Dacryocystitis (disorder), Dacryocystitis, NOS
Swedish Tårsäcksinflammation
Dutch dacryocystitis, dacryocystitis NAO, dacryocystitis, niet-gespecificeerd, Dacryocystitis
French Dacryocystite, non précisée, Dacryocystite SAI, Dacryocystite
German Dakryozystitis NNB, Dakryozystitis, unspezifisch, Dakryozystitis, Tränensackentzündung
Italian Dacriocistite NAS, Dacriocistite, non specificata, Dacriocistite
Portuguese Dacriocistite NE, Dacriocistite
Spanish Dacriocistitis no especificada, Dacriocystitis, Dacriocistitis NEOM, dacriocistitis, SAI (trastorno), dacriocistitis, SAI, dacriocistitis no especificada, dacriocistitis no especificada (trastorno), dacriocistitis (trastorno), dacriocistitis, Dacriocistitis
Japanese 涙嚢炎, ルイノウエンNOS, 涙嚢炎NOS, 涙嚢炎、詳細不明, ルイノウエンショウサイフメイ, ルイノウエン
Czech dakryocystitida, Dakryocystitida, Dakryocystitida, NOS, Dakryocystitida, blíže neurčená, zánět slzného vaku
Finnish Kyynelpussitulehdus
Russian DAKRIOTSISTIT, DAKRIOADENIT, ДАКРИОАДЕНИТ, ДАКРИОЦИСТИТ
Croatian DAKRIOCISTITIS
Polish Zapalenie woreczka łzowego
Hungarian dacryocystitis, dacryocystitis k.m.n., Dacryocystitis, nem meghatározott
Norwegian Dakryocystitt, Tåresekkbetennelse