Acute dacryocystisis

acute dacryocystisis and its management

1. Acute Dacryocystisis Nayab farhana(b.optom)

2. contents What is acute dacryocystisis Sign and symptoms Pathophysiology prognosis Stages of dacryocystiss How to manage Role of an optometrist Reference conclusion

3. Acute dacryocystisis Dacryocystitis  is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. The term derives from the Greek dákryon (tear), cysta (sac), and -itis (inflammation). It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora.

4. Signs and symptoms Pain, swelling, redness over the lacrimal sac at medial canthus Tearing, crusting, fever Digital pressure over the lacrimal sac may extrude pus through the punctum In chronic cases, tearing may be the only symptom

5. Pathophysiology A variety of causes may lead to dacrocystitis. Most notably, obstruction of the nasolacrimal duct leads to stasis of the nasolacrimal fluid, which predisposes to infection.  Staphylococcus aureus  is a common bacterial pathogen causing infectious dacrocystitis. Sometimes, especially in women, stones may develop in the lacrimal gland, causing recurrent bouts of dacrocystitis; this condition is called "acute dacryocystic retention syndrome.“ Also due to pneumococcus, infection due to surrounding structure such as paranasal sinuses.

6. Prognosis About 60 percent of initial attacks of dacryocystitis will recur. Individuals with a poorly functioning immune system (immunocompromised) may develop  orbital cellulitis , which may lead to  optic neuritis ,  proptosis , motility abnormalities, or  blindness .

7. Stages of acute dacryocystisis It can be divided into 3 stages stages of cellulitis Stages of lacrimal absecces Stages of fistula formation

8. Complications Acute conjunctivitis. Corneal abrasion which may lead to corneal ulceration. Lid abscess. Osteomyelitis of lacrimal bone. Orbital cellulitis. Facial cellulitis and ethmoiditis. rArely cavernois sinus thrombosis and very rarely generalised septicaemia may also develop.

9. Treatment During cellulitis stage Systemic(ciprofloxacine, cephalosporin or tetracycline or cotrimoxazole, for 7 days) topical antibiotics to control infection. Systemic anti inflammatory, analgesic drugs and hot fomentation to relieve pain and swelling.

10. During lacrimal abcess In addition to the above treatment when pus started pointing on the skin, it should be drain out by small incision. The pus should be squeezed out gentaly, and dressing should be sone with betadiene. Later depending on the condition of lacrimal sac either dct or dcr is done otherwise reccurence will occur.

11. During external lacrimal fistula After controlling the acute dacryocystisis woth systemic antibiotics, fistulectomy along with dct or dcr operation should be perform.

12. Management by optometrist Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere Non pharmacological Do not attempt to probe the lacrimal system during acute infection (risk of spreading infection) Pharmacological Topical antibiotic to prevent bacterial conjunctivitis: e.g. chloramphenicol drops and/or ointment for not less than 5 days For mild and non-febrile cases, consider prescribing systemic antibiotic, e.g. co-amoxiclav or, where there is a penicillin allergy, erythromycin

13. conclusions Acute dacryocystisis is painful infection of lacrimal sac. Treated with antibiotic and anti inflammatory drugs. Probing shall not be done by optometrist at the stage of lacrimal abcess as it may lead to infections. Reffer to ophthalmologist. Various ocular complications is associated with it.

14. reference A.k.khurana textbook of ophthalmology, 5 th edition. Parkson’s textbook of ophthalmology, 22 nd edition. eyewiki

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