Dacryocystitis: Difference between revisions
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Revision as of 15:43, 22 March 2016
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
Diagnosis
- 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
- Ocular compartment syndrome
- 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
Treatment
- Oral clindamycin for 7-10 days
- If ill appearing - IV cephalosporin (cefuroxime 50 mg/kg IV Q8h or cefazolin 33 mg/kg IV Q6H) or clindamycin (10 mg/kg IV Q8H)
- If MRSA suspected - Vancomycin 10-13 mg/kg IV Q6-8 h
- Chronic dacryocystitis - topical ABX (fluoroquinolone or erythromycin)
- Consult ophthalmology (outpt referral follow-up)
Sources
Tintinalli 7th ed, p. 764; UpToDate