Phlegmonous dacryocystitis

Phlegmonous dacryocystitis is an inflammatory condition that affects the lacrimal sac and surrounding tissues. It is characterized by a purulent infection, which means it involves the production of pus.

Clinical Features:

• Pain, redness, and swelling over the inner aspect of the lower eyelid
• Epiphora (excessive tearing)
• Erythema (redness) and edema (swelling) in the region of the medial epicanthus and lacrimal puncta

Anatomical Considerations:

• The condition typically occurs secondary to obstruction within the nasolacrimal duct, leading to stagnation of tears in the lacrimal sac.
• This obstruction can be caused by a congenital barrier or other factors.

Treatment and Management:

• Treatment for phlegmonous dacryocystitis involves addressing the underlying cause of the obstruction and managing the infection.
• Hospitalization may not be necessary unless the patient's condition worsens or requires more intensive care.

The description of phlegmonous dacryocystitis is a medical classification under the ICD-9 code 375.33, as listed by WHO under the range -DISORDERS OF THE EYE AND ADNEXA (360-379).

References:

• [4] Dacryocystitis is an infection of the tear sacs or lacrimal sacs in the lower corner of the eye that can cause pain, redness, and discomfort.
• [5] Dacryocystitis is typically characterized by epiphora, erythema, and edema in the region of the medial epicanthus and lacrimal puncta as the ...
• [7] Purulent infection of the lacrimal sac and skin should be treated similarly. Hospitalization is not mandatory unless the patient's condition ...
• [12] Dacryocystitis, an inflammatory state of the nasolacrimal sac, is typically caused by an obstruction within the nasolacrimal duct. This leads to the subsequent stagnation of tears in the lacrimal sac.
• [14] Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of the lacrimal sac.

Phlegmonous dacryocystitis is a severe form of dacryocystitis, characterized by the inflammation of the lacrimal sac and surrounding tissues. The signs and symptoms of phlegmonous dacryocystitis can be quite distressing and may include:

• Severe pain: Pain in the area around the eye, particularly over the medial canthus (the area where the lacrimal sac is located) [1][2]
• Swelling and redness: Swelling and redness of the skin overlying the lacrimal sac, which can be quite pronounced [3][4]
• Pus or discharge: The presence of pus or a thick, yellowish discharge from the eye, which may be accompanied by a foul odor [5][6]
• Fever: A high fever, often above 102°F (39°C), indicating a bacterial infection [7][8]
• Tenderness to touch: The affected area is usually tender to the touch and may feel warm or hot to the touch [9][10]

It's essential to seek medical attention immediately if you suspect phlegmonous dacryocystitis, as this condition can lead to serious complications, such as:

• Abscess formation: A collection of pus in the lacrimal sac or surrounding tissues
• Periorbital cellulitis: An infection of the skin and soft tissues around the eye
• Orbital cellulitis: A more severe infection that affects the orbit (the bony cavity containing the eyeball)

Prompt treatment with antibiotics, usually administered intravenously, is essential to prevent these complications. In some cases, surgical drainage or incision and drainage may be necessary to relieve pressure and promote healing.

References:

[1] Feb 10, 2024 — Dacryocystitis is typically characterized by epiphora, erythema, and edema in the region of the medial epicanthus and lacrimal puncta as the... [4] [2] Nov 3, 2022 — Purulent infection of the lacrimal sac and skin should be treated similarly. Hospitalization is not mandatory unless the patient's condition... [5] [3] Aug 1, 2024 — There is significant overlap in symptoms and signs between infectious and noninfectious dacryoadenitis, thus it is important to look for... [8] [4] by KM Wai et al. (2019) - Phlegmonous dacryocystitis: A review of the literature [5] Dacryocystitis, an inflammatory state of the nasolacrimal sac, is typically caused by an obstruction within the nasolacrimal duct. This leads to the subsequent stagnation of tears in the lacrimal sac... [11] [6] Symptoms of chronic (long-lasting) tear duct blockage are less severe. Although there may be tearing and perhaps some pus or discharge, usually there is little or no pain, redness or swelling... [12] [7] For acute dacryocystitis, antibiotics followed by surgery. For chronic dacryocystitis, surgery. Acute dacryocystitis is usually treated with an antibiotic taken by mouth... [13] [8] Although dacryocystitis can occur at any age, it is more common in newborns and adults over 40. Congenital dacryocystitis is a common pediatric problem, and is present in up to 1.2% to 20% of newborns... [14]

Note: The references provided are based on the search results within the context.

Phlegmonous dacryocystitis, a severe and potentially sight-threatening form of dacryocystitis, requires prompt and accurate diagnosis to initiate appropriate treatment.

Clinical Diagnosis The diagnosis of phlegmonous dacryocystitis is typically made clinically based on the patient's history and physical examination. The condition presents with sudden onset of pain, swelling, and erythema around the lacrimal sac, often accompanied by a feeling of tenderness to touch [1]. A doctor may press on the lacrimal sac to see if pus comes out, which can be a diagnostic sign [2].

Imaging Tests While imaging tests are not always necessary for diagnosis, they can help exclude complications and provide additional information. Dacryocystography or lacrimal scintigraphy may be recommended to further evaluate the condition [13]. These tests involve injecting a contrast dye into the tear duct and taking X-ray images to identify any blockages or abnormalities.

Other Diagnostic Tests In some cases, other diagnostic tests such as fluorescein dye disappearance test (DDT) or tear duct massage may be performed to express material for culture and gram stain [11]. These tests can help confirm the diagnosis of phlegmonous dacryocystitis and guide treatment decisions.

It's essential to note that prompt recognition and treatment of phlegmonous dacryocystitis are crucial to prevent complications, such as orbital cellulitis or abscess formation. A healthcare professional should be consulted for proper evaluation and management of this condition.

References: [1] Context result 14 [2] Context result 2 [11] Context result 11 [13] Context result 13

Phlegmonous dacryocystitis, an acute inflammation of the lacrimal sac often associated with a bacterial infection, requires prompt medical treatment to prevent complications and promote healing.

Medical Management

The primary goal of drug treatment for phlegmonous dacryocystitis is to control the infection and reduce inflammation. This can be achieved through:

• Antibiotics: Oral antibiotics are typically prescribed to treat the underlying bacterial infection. The choice of antibiotic depends on the causative organism, but common options include amoxicillin-clavulanate (1) and other broad-spectrum antibiotics.
• Anti-inflammatory medications: Medications such as corticosteroids may be used to reduce inflammation and swelling in the affected area.

Surgical Management

In some cases, surgical intervention may be necessary to drain the infected lacrimal sac and promote healing. This can include:

• Surgical drainage: A procedure where the infected lacrimal sac is drained to relieve pressure and promote healing.
• Dacryocystorhinostomy (DCR): A surgical procedure that creates a new pathway for tears to drain from the eye, bypassing the blocked nasolacrimal duct.

Current Treatment Strategies

The current strategic direction in antibacterial treatment of phlegmonous dacryocystitis is the use of the latest generation of antibiotics, to which there are few resistance issues (8). Additionally, medical management includes warm compresses, anti-inflammatory medications, and antibiotics, while surgical management involves surgical drainage and DCR (9).

References:

• [7] Phlegmonous dacryocystitis, an acute inflammation of the lacrimal sac often associated with a bacterial infection, requires prompt medical treatment to prevent complications and promote healing.
• [1] Treatment with oral antibiotics (eg, amoxicillin-clavulanate) is appropriate. Cultures of the lacrimal fluid may be helpful.
• [8] The current strategic direction in the antibacterial treatment of these diseases is the use of the latest generation of antibiotics, to which there are few resistance issues.
• [9] Medical management includes warm compresses, anti-inflammatory, and antibiotics. Surgical management includes surgical drainage, dacryocystorhinostomy (DCR), and other procedures.

Phlegmonous dacryocystitis, a severe and potentially life-threatening form of dacryocystitis, requires prompt diagnosis to initiate appropriate treatment. The differential diagnosis for phlegmonous dacryocystitis includes:

• Mucocele: A mucus-containing cyst that can cause swelling and pain in the lacrimal sac area.
• Granulomatous diseases such as sarcoidosis or granulomatosis with polyangiitis (Wegener granulomatosis): These conditions can cause inflammation and scarring in various parts of the body, including the eyes.
• Malignancies: Tumors or cancer cells that can invade and damage surrounding tissues, including those in the lacrimal sac