acute dacryocystitis

Acute Dacryocystitis: A Sudden Infection of the Tear Sac

Acute dacryocystitis is a sudden and short-term infection or inflammation of the lacrimal sac, which is responsible for draining tears from the eyes into the nose. This condition typically lasts less than three months [1].

Common Symptoms

The symptoms of acute dacryocystitis may occur over several hours to several days and are characterized by:

• Pain in the medial canthal region (the area between the eye and the nose)
• Redness and swelling in the same area
• Erythema (redness) that can extend to involve the bridge of the nose
• Purulent material (a thick, yellowish discharge) that may be expressed from the lacrimal sac [2]
• Eye pain, redness, and discomfort due to the blockage of the nasolacrimal duct [3]

Common Causative Organisms

The most common bacteria related to acute dacryocystitis are Staphylococcus species, beta-hemolytic streptococci, pneumococci, and Haemophilus influenzae [4].

Treatment

Symptoms of acute dacryocystitis resolve quickly with proper treatment. However, definitive treatment for resolved acute dacryocystitis or chronic conjunctivitis is usually surgery that creates a passage between the lacrimal sac and the nasal cavity (dacryocystorhinostomy) [5].

References:

[1] Context 1 [2] Context 2 [3] Context 4 [4] Context 13 [5] Context 6

Common Signs and Symptoms of Acute Dacryocystitis

Acute dacryocystitis can manifest in various ways, making it essential to recognize the symptoms for prompt treatment.

• Pain: The area around the tear sac is painful, often accompanied by a dull ache or tenderness [3].
• Redness and Swelling: The inner corner of the eye, near the tear sac, becomes red and swollen due to inflammation [1][3][5].
• Watery Eye: Excessive tearing can occur as a result of the infection [5][9].
• Pus or Discharge: A yellowish or greenish discharge may ooze from the affected area, indicating the presence of pus [4][7][9].
• Fever: In some cases, fever can accompany acute dacryocystitis, especially if the infection is severe [4].

It's crucial to seek medical attention if you experience any of these symptoms, as prompt treatment can help alleviate discomfort and prevent complications.

References: [1] - Context result 2 [3] - Context result 3 [5] - Context result 5 [7] - Context result 7 [9] - Context result 9

Diagnostic Tests for Acute Dacryocystitis

Acute dacryocystitis, a severe form of the condition, requires prompt diagnosis and treatment to prevent complications. The following diagnostic tests can be used to confirm the diagnosis:

• Imaging studies: In cases where there are visual changes, fever, and orbital cellulitis, imaging studies such as CT scans may be ordered to assess the extent of infection and differentiate between preseptal and postseptal cellulitis [3].
• Blood tests: A complete blood count (CBC) can be performed to assess the degree of leukocytosis, which is a common finding in cases of dacryocystitis [1].
• Tear drainage test: This test measures how quickly tears are draining and may be used to confirm the diagnosis of dacryocystitis. A special dye is placed on the surface of each eye, and the rate at which it drains can indicate whether there is an obstruction in the nasolacrimal duct [4].
• Dacryocystography (DCG): This imaging test can be performed when anatomical abnormalities are suspected, such as a foreign body or mass obstructing the nasolacrimal duct [7].

Clinical Diagnosis

In most cases, dacryocystitis is diagnosed clinically based on the patient's history and physical examination. A doctor will assess symptoms such as redness, swelling, and discharge from the eye, as well as perform a thorough examination to confirm the diagnosis [2].

Treatment Options for Acute Dacryocystitis

Acute dacryocystitis, an infection of the tear ducts, can be effectively treated with various medications. The primary goal is to eliminate the bacterial infection and alleviate symptoms.

• Oral Antibiotics: For mild cases or uncomplicated infections, oral antibiotics are often prescribed. Commonly used antibiotics include:
  • Cephalexin (e.g., [4])
  • Amoxicillin-clavulanate (Augmentin) (e.g., [5])
  • Ciprofloxacin (e.g., [7])
• Intravenous Antibiotics: In more severe cases or when the infection is accompanied by orbital cellulitis, intravenous antibiotics may be required. Possible antibiotic alternatives include:
  • Ampicillin-sulbactam
  • Ceftriaxone
  • Moxifloxacin (e.g., [12])
• Antibiotic Eye Drops/Ointments: In some cases, especially for mild infections or small flare-ups, antibiotic eye drops or ointments may be considered. These can help target the infection directly in the tear ducts.

Important Considerations

When prescribing antibiotics, it's essential to consider factors such as:

• Gram-positive organisms: The primary focus should be on targeting gram-positive bacteria, particularly Staphylococcus aureus (e.g., [3]).
• Liver function: Certain antibiotics may be contraindicated in patients with acute liver injury or liver disease (e.g., [10]).

Treatment Approach

The most common treatment approach for acute dacryocystitis involves a combination of:

1. Warm compresses to relieve symptoms
2. Oral antibiotics to eradicate the underlying bacterial infection

By addressing the infection and alleviating symptoms, patients can experience significant improvement in their condition.

Differential Diagnosis of Acute Dacryocystitis

Acute dacryocystitis, an infection or inflammation of the lacrimal sac, can be challenging to diagnose due to its similarity in symptoms with other conditions. The differential diagnosis for acute dacryocystitis includes:

• Periorbital swelling: This condition can present with similar symptoms as acute dacryocystitis, including redness and swelling around the eye.
  • Proptosis: A condition where the eyeball is bulging out of the orbit (3.1.1)
  • No proptosis: A condition where there is no bulging of the eyeball (3.1.2)
  • Lid complications: Conditions affecting the eyelids, such as blepharitis or chalazion (3.1.3)
• Mucocele: A condition where a mucous-filled sac forms in the lacrimal sac or surrounding tissues.
• Granulomatous diseases: Such as sarcoidosis or granulomatosis with polyangiitis, which can cause inflammation and infection in the lacrimal sac (4).
• Acute ethmoid sinusitis: An infection of the ethmoid sinuses, which can present with similar symptoms to acute dacryocystitis.
• Lacrimal sac or sinonasal tumor: A type of cancer that affects the lacrimal sac or surrounding tissues.
• Infected sebaceous cyst: A condition where a sebaceous cyst becomes infected and inflamed.

Key Points

• The differential diagnosis for acute dacryocystitis is broad and includes various conditions that can present with similar symptoms.
• A thorough history, physical examination, and imaging studies are essential to diagnose the underlying cause of the symptoms.
• Contrast-enhanced computed tomography (CT) scans can aid in the diagnosis by providing detailed images of the lacrimal sac and surrounding tissues.

References

• [5] Dacryocystitis is an acute bacterial infection of lacrimal sac, usually secondary to obstruction of the nasolacrimal duct.
• [15] Acute dacryocystitis is inflammation of the lacrimal sac. Common implicated causative organisms are Staphylococcus species, beta-hemolytic streptococci, ... The differential diagnosis includes acute ethmoid sinusitis, lacrimal sac or sinonasal tumor, and infected sebaceous cyst.