Dacryocystitis - Causes, Symptoms and Treatment
What is Dacryocystitis?
Dacryocystitis is an infection of the lacrimal sac. In infants, it results from congenital atresia of the nasolacrimal duct. In adults, it results from an obstruction (dacryostenosis) of the nasolacrimal duct (most often in women over age 40 years). Dacryocystitis can be acute or chronic.
What are the Causes of Dacryocystitis?
Dacryocystitis in infants occurs as a result of atresia of the nasolacrimal ducts due to failure of canalization or, in the first few months of life, from blockage when the membrane that separates the lower part of the nasolacrimal duct and the inferior nasal meatus fails to open spontaneously before tear secretion. Bony obstruction of the duct may also occur.
In adults, dacryocystitis can be caused by microbes infecting the lacrimal sac. In acute dacryocystitis, Staphylococcus aureus and, occasionally, beta-hemolytic streptococci are the cause. In chronic dacryocystitis, Streptococcus pneumoniae or, sometimes, a fungus - such as Actinomyces or Candida albicans - is the causative organism. Primary and secondary tumors of the sinus, nose, and orbits also may cause dacryocystitis.
What are the Signs and Symptoms of Dacryocystitis?
The hallmark of both the acute and chronic forms of dacryocystitis is constant tearing. Other symptoms of dacryocystitis include inflammation and tenderness over the nasolacrimal sac; pressure over this area may fail to produce purulent discharge from the punctum. Acute dacryocystitis is extremely painful.
Diagnosis for Dacryocystitis.
Clinical features and a physical examination suggest dacryocystitis. Culture of the discharged material demonstrates S. aureus and, occasionally, beta-hemolytic streptococci in acute dacryocystitis, and S. pneumoniae or C. albicans in the chronic form. The white blood cell count may be elevated in the acute form; in the chronic form, it's generally normal. An X-ray after injection of a radiopaque medium (dacryocystography) locates the atresia in infants.
Treatment for Dacryocystitis
Treatment of acute dacryocystitis consists of warm compresses, topical and systemic antibiotic therapy and, occasionally, incision and drainage. Chronic dacryocystitis may eventually require dacryocystorhinostomy.
Therapy for nasolacrimal duct obstruction in an infant consists of careful massage of the area over the lacrimal sac four times a day for 6 to 9 months. If this fails to open the duct, dilation of the punctum and probing of the duct are necessary.
Special Considerations and Prevention Tips for Dacryocystitis
1) Check the patient history for possible allergy to antibiotics before administration. Emphasize the importance of precise compliance with the prescribed antibiotic regimen.
2) Tell the adult patient what to expect after surgery: He'll have ice compresses over the surgical site and will have bruising and swelling.
3) Monitor blood loss by counting dressings used to collect the blood.
4) Apply ice compresses postoperatively. A small adhesive bandage may be placed over the suture line to protect it from damage.
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