Dacryocystitis

Background

• Acute or chronic inflammation and bacterial infection of the lacrimal sac
  • Most common pathogens: Strep. pneumoniae, staph. aureus, staph. epidermidis, h. influenzae
• Most common in children
• Often after viral URI
• Complications: Periorbital Cellulitis, Orbital Cellulitis

Clinical Features

• Mucopurulent material expressed from nasolacrimal sac
• Erythema and edema between medial canthus and nasal bridge

Evaluation

• Physical exam
• May culture purulent material

Differential Diagnosis

Periorbital swelling

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

Management

• Oral clindamycin for 7-10 days
• If ill appearing: IV cephalosporin (cefuroxime 50mg/kg IV Q8h or cefazolin 33mg/kg IV Q6H) or clindamycin (10mg/kg IV Q8H)
  • If MRSA suspected: Vancomycin 10-13mg/kg IV Q6-8 h
• Chronic dacryocystitis: topical antibiotic (fluoroquinolone or erythromycin)
• Consult ophthalmology (outpatient referral follow-up)

References

• Tintinalli 7th ed, p. 764

Authors

Lauren Westafer, Ross Donaldson, Kevin Lu, Neil Young, Daniel Ostermayer