Acute dacryocystitis

OPTHAL MBBS

1. ANUDEEPA . M 4298 31/8/15 Faculty in charge:Dr Ananth Bhandary ACUTE DACRYOCYSTITIS

2. CONTENTS Definition Etiology Predisposing factors Causative organisms Clinical picture Complications Treatment

3. ACUTE DACRYOCYSTITIS Acute Dacryocystitis is an acute suppurative inflammation of the lacrimal sac, characterised by the presence of a painful swelling in the region of sac.

4. ETIOLOGY It may develop in two ways; As an acute exacerbation of chronic dacryocystitis As an acute peridacryocystitis due to direct involvement from the neighbouring infected structures such as; paranasal sinuses, surrounding bones, dental abscess or caries teeth in the upper jaw.

5. PREDISPOSING FACTORS Age: more common between 40-60 years Sex: predominantly seen in females probably due to camparatively narrow lumen of the bony canal Heridity : plays an indirect role, it affects the facial configuration and so also the length and width of the bony canal Poor personal hygeine

6. CAUSATIVE ORGANISMS Commonly involved are; Streptococcus haemolyticus Pneumococcus Staphylococcus

7. CLINICAL PICTURE It can be divided into 3 stages; Stage of cellulitis Stage of lacrimal abscess Stage of fistula formation

8. STAGE OF CELLULITIS It is characterised by; Painful swelling in the region of lacrimal sac Swelling is red, hot, firm and tender Redness and oedema also spread to the lids and cheeks Epiphora Constitutional symptoms such as fever, malaise When treated resolution may occur at this stage, if untreated self resolution is rare

9. STAGE OF LACRIMAL ABSCESS Continued inflammation causes occlusion of the canaliculi due to oedema The sac is filled with pus, distends and its anterior wall ruptures forming a pericystic swelling In this way a large fluctuant swelling, the lacrimal abscess is formed It usually points below and to the outer side of the sac due the gravitation of pus and the presence of medial palpebral ligament in the upper part

10. LACRIMAL ABSCESS

11. STAGE OF FISTULA FORMATION When the lacrimal abscess is left unattended, it discharges spontaneously, leaving an external fistula below the medial palpebral ligament Rarely, the abscess may open up into the nasal cavity forming an internal fistula

12. EXTERNAL LACRIMAL FISTULA

13. COMPLICATIONS Acute conjunctivitis Corneal abrasion which may be converted to corneal ulceration Lid abscess Osteomyelitis of lacrimal bone Orbital cellulitis Facial cellulitis and acute ethmoiditis Rarely cavernous sinus thrombosis and very rarely generalised septicaemia may also develop

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

15. During stage of lacrimal abscess; In addition to the above treatment when pus starts pointing on the skin, it should be drained with a small incision. The pus should be gently squeezed out, the dressing should be done with betadine Later depending upon condition of the lacrimal sac either DCT or DCR operation should be carried out, otherwise recurrence will occur

16. During external lacrimal fistula; After controlling the acute infection with systemic antibiotics, fistulectomy along with DCT or DCR operation should be performed

17. REFERENCE A K Khurana Textbook of Ophthalmology, 5 th edition Parsons’ Textbook of Ophthalmology, 22 nd edition.

18. THANKYOU