By Dr.Ahmad Riaz
Spot Diagnosis? Management?
By Dr.Tablo Merza Acute dacryocystitis
By Dr.Munawar Ali Acute Dacrocystitis with fistula
By Dr.Mohammad Ibrahim Salem keratin filled cyst or sebaceous cyst
Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora. When nasolacrimal duct obstruction is secondary to a congenital barrier it is referred to as dacrocystocele. It is most commonly caused by Staphylococcus aureus and Streptococcus pneumoniae. The most common complication is corneal ulceration, frequently in association with S. pneumoniae.The mainstays of treatment are oralantibiotics, warm compresses, and relief of nasolacrimal duct obstruction by dacryocystorhinostomy.
The treatment of dacryocystitis depends upon the clinical manifestations of the disease.
Acute dacryocystitis with orbital cellulitis necessitates hospitalization with intravenous (IV) antibiotics.
- Appropriate neuroimaging studies should be obtained, and surgical exploration and drainage should be performed for focal collections of pus.
- IV empiric antimicrobial therapy for penicillin-resistant Staphylococcus(nafcillin or cloxacillin) should be initiated immediately.
- Blood cultures and cultures of the lacrimal secretions should be obtained prior to antibiotic therapy.
- Treatment with warm compresses may aid in resolution of the disease.
- Impending perforation should be treated with a stab incision of the skin.
Purulent infection of the lacrimal sac and skin should be treated similarly. Hospitalization is not mandatory unless the patient’s condition appears serious.
- Treatment with oral antibiotics (eg, Augmentin) is appropriate.
- Cultures of the lacrimal fluid should be obtained. The presence of a lacrimal sac mucocele in adults mandates treatment even if asymptomatic.
- The treatment of choice is a dacryocystorhinostomy whether the patient is symptomatic or not. Probing should not be performed because mucoceles often are not sterile and probing may incite a cellulitis.
Patients with chronic dacryocystitis caused by a partial or intermittent nasolacrimal duct obstruction may benefit from topical steroid drop treatment.
Congenital chronic dacryocystitis may resolve with lacrimal sac massage, warm compresses, and topical and/or oral antibiotics.