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Acute Dacryocystitis


Presentation

  • , clinical presentation, and management outcome.[ncbi.nlm.nih.gov]
  • The purpose of this study is to describe presentation and management of cases of acute dacryocystitis presenting as orbital cellilitis and abscess secondary to acute dacryocystitis.[ncbi.nlm.nih.gov]
  • RESULTS: The mean age at presentation was 39.2 years. Sixty percent of patients (12/20) presented with acute dacryocystitis, 35% (7/20) with a lacrimal abscess, and 5% (1/20) with a dacryopyocele following a failed probing.[ncbi.nlm.nih.gov]
  • Dacryocystitis with preseptal cellulitis can be a presenting sign of leukemia. This blood malignancy should be considered in patients whose leukocyte counts do not correlate with their clinical presentation.[ncbi.nlm.nih.gov]
  • Acute dacryocystitis usually presents as a preseptal infection, but can uncommonly be associated with orbital cellulitis. Orbital abscess formation is, however, very rare.[ncbi.nlm.nih.gov]
Fever
  • Oculoglandular tularemia is not only suspected in cases who complain of fever, cervical lymphadenopathy and purulent conjunctivitis, it should also be suspected in cases who are admitted to the hospital with acute dacryocystitis, which is a rare component[ncbi.nlm.nih.gov]
  • 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[slideshare.net]
  • Acute: Stage of Cellulitis: Signs of inflammation in sac area, epiphora, fever, malaise Stage of Lacrimal abscess: Fluctuant swelling, pus point (below and outer side) Stage of Fistula formation: below medial palpebral ligament C.[epomedicine.com]
  • […] surgery Congenital obstruction of nasolacrimal duct (see Clinical Management Guideline on Nasolacrimal Duct Obstruction ) Symptoms Sudden onset Pain Tender swelling over lacrimal sac (anatomically located just below the medial palpebral ligament) Epiphora Fever[college-optometrists.org]
  • Also, over-the-counter pain relievers and anti-inflammatory medications may help manage pain and fever until definitive treatment with antibiotics or surgery takes place.[medicalnewstoday.com]
Mucosal Edema
  • Nasal mucosal edema, lymphoid hyperplasia, and exudate obstructed the ostium of his left nasolacrimal duct. The patient improved rapidly with systemic antibiotic and nasal decongestant drugs.[ncbi.nlm.nih.gov]
Regurgitation
  • Lacrimal sac massage showed a regurgitation of a purulent discharge from the left lower punctum. Therefore, the patient was diagnosed with acute dacryocystitis and an endoscopic transnasal dacryocystostomy was performed the next day.[ncbi.nlm.nih.gov]
  • Chronic: Catarrhal stage (mild inflammation): epiphora /- mild redness in sac area Regurgitation test: clear fluid or few fibrinous mucoid flakes Stage of lacrimal mucocele: epiphora swelling in sac area Regurgitation test: milky/gelatinous mucoid fluid[epomedicine.com]
  • Chronic dacryocystitis was diagnosed in patients with persistent epiphora and regurgitation of mucoid or mucopurulent material on pressure over the sac area or regurgitation of mucoid or mucopurulent discharge on irrigation of the lacrimal drainage system[nature.com]
  • Pressure on this will usually cause regurgitation into the conjunctival sac or, less often, into the nose. Irrigation of the sac through the punctum and the canaliculus causes the contents to be washed into[jamanetwork.com]
  • . – Regurgitation of discharge from the punctum on applying pressure over lacrimal sac area. – Congenital lacrimal sac mucocele (also called congenital dacryocele or amniontocele).[aimu.us]
Dental Abscess
  • 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[slideshare.net]
  • Acute: Exacerbation of chronic dacryocystitis Acute peridacryocystitis (neighboring structures): Paranasal sinus, bones, dental abscess, caries teeth b.[epomedicine.com]
Disfiguring Scar
  • Complications included disfiguring scar in 4, recurrent acute dacryocystitis in 3, and punctal ectropion in one patient in the EXT-DCR group.[ncbi.nlm.nih.gov]
Unilateral Epiphora
  • ., Actinomyces spp. and Propionibacterium spp. [ 15 ] Presentation Symptoms Unilateral epiphora. Chronic mucopurulent conjunctivitis (refractory to usual treatment).[patient.info]
Facial Swelling
  • A middle-aged poorly controlled diabetic man developed left-sided orbital and facial swelling several days after extraction of a left upper wisdom tooth. The clinical impression was that of acute dacryocystitis.[ncbi.nlm.nih.gov]

Workup

Gram-Positive Bacteria
  • Most microorganisms were Gram-positive bacteria (45 samples or 57.0% of all positive culture samples), whereas Gram-negative bacteria, anaerobic bacteria, and fungi were found in 39 (49.4%), 24 (30.4%), and four samples (5.1%), respectively.[dovepress.com]
  • […] nasolacrimal duct Commonest in infants and post-menopausal women Relatively rare in older children Infection may be due to Gram positive or Gram-negative organisms: Staphylococcus aureus and Streptococcus pneumoniae are the most common isolates amongst Gram-positive[college-optometrists.org]
  • Gram-positive bacteria are the most common cause of acute dacryocystitis.[aao.org]
Kingella
  • ., Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella kingae) group commonly associated with endocarditits and is normally present in the respiratory tract.[ncbi.nlm.nih.gov]
Eikenella
  • ., Actinobacillus actinomycetemcomitans, C. hominis, Eikenella corrodens, and Kingella kingae) group commonly associated with endocarditits and is normally present in the respiratory tract.[ncbi.nlm.nih.gov]
Gram-Positive Rods
  • The most frequently isolated group was coagulase-negative staphylococci (27.8%), followed by nonspore-forming Gram-positive rods (anaerobe) (17.7%) and Pseudomonas aeruginosa (15.2%).[dovepress.com]
Francisella Tularensis
  • It is difficult to culture francisella tularensis on media so serological tests such as micro-agglutination methods are used to diagnose the infection. PCR test results were weak positive.[ncbi.nlm.nih.gov]

Treatment

  • PURPOSE: Conventional treatment for acute dacryocystitis consists of medical management followed by elective delayed external dacryocystorhinostomy (EXT-DCR).[ncbi.nlm.nih.gov]
  • Outcomes were compared between both groups, considering resolution time for external acute inflammation, success rate of free lacrimal passage reconstruction, and lack of complications as indicators of treatment suitability.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Endonasal dacryocystorhinostomy may be a useful option in the treatment of acute dacryocystitis with abscess formation.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Primary endoscopic dacryocystorhinostomy is an effective treatment in cases of acute dacryocystitis complicated by abscess formation.[ncbi.nlm.nih.gov]
  • Complete success was achieved in 25 (96.2%) cases; the only failure was in a patient who had previously undergone radioiodine treatment. In this case, revision Endo-DCR was not successful.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis [ edit ] About 60 percent of initial attacks of dacryocystitis will recur. [3] Individuals with a poorly functioning immune system (immunocompromised) may develop orbital cellulitis, which may lead to optic neuritis, proptosis, motility abnormalities[en.wikipedia.org]
  • Treatment and prognosis Treatment is usually with antibiotics in the acute phase. In some cases, intervention (including external dacryocystorhinostomy) may be necessary.[radiopaedia.org]
  • Treatment Medical antibiotics Surgical Dacryocystorhinostomy for chronic dacryocystitis Prognosis, Prevention, and Complications Can spread to cavernous sinus resulting in thrombosis and meningitis Please rate topic.[medbullets.com]
  • Prognosis If more conservative approaches fail to clear the obstruction, surgical procedures are available, with success rates greater than 90%. Prevention In many cases, the cause of a lacrimal duct obstruction is not known.[encyclopedia.com]
  • Prognosis Treatment of dacryocystitis with antibiotics is usually successful in clearing the infection that is present. If there is a permanent blockage that prevents drainage, infection may recur and surgery may be required to open the duct.[medical-dictionary.thefreedictionary.com]

Etiology

  • Occasionally acquired etiologies and rare organisms like Pantoea sp., Epstein-Barr Virus, and Sporothrix are implicated in the etiopathogenesis. The diagnosis is usually clinical aided by laboratory investigations.[ncbi.nlm.nih.gov]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Keywords Abscess/surgery — Acute Disease — Dacryocystitis/complications/surgery — Dacryocystorhinostomy — Drainage — Female — Humans — Lacrimal Apparatus Diseases/etiology/surgery — Lacrimal Duct Obstruction/etiology — Middle Aged — Tomography — X-Ray[archive-ouverte.unige.ch]
  • Abscess Bacterial infections Case reports [Publication type] Cellulitis Dacryocystitis/complications Lacrimal apparatus diseases Orbital diseases/etiology Cite this Apa Standard Harvard Vancouver BIBTEX RIS Martins, MC, da Silva Ricardo, JR, Akaishi,[jhu.pure.elsevier.com]

Epidemiology

  • Keywords: 357 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 454 laser • 328 bacterial disease 2002, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved.[iovs.arvojournals.org]
  • Epidemiological characteristics and laboratory diagnosis of fungal keratitis. A three-year study. Indian J Ophthalmol 2003; 51 : 315–321. 24. Bharathi MJ, Ramakrishnan R, Vasu S, Meenakshi R, Palaniappan R.[nature.com]
  • Epidemiology It is more common in females. It tends to occur either in infants (uncommon) or in adults (much more common) over the age of 40 years, peak age 60-70 years.[patient.info]
  • Epidemiology Frequency United States Individuals with brachycephalic heads have a higher incidence of dacryocystitis than dolichocephalic or mesocephalic skulls.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • […] dacryocystorhinostomy. [2] Signs and symptoms [ edit ] 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 Pathophysiology[en.wikipedia.org]
  • A special form of inflammation of the lacrimal sac is that of congenital dacryocystitis, the pathophysiology of which is intimately related to the lacrimal excretory system embryogenesis.[emedicine.medscape.com]

Prevention

  • Early diagnosis, prompt intravenous antibiotic administration, and aggressive surgical debridement will prevent the associated morbidity and mortality.[ncbi.nlm.nih.gov]
  • Keywords: 357 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 454 laser • 328 bacterial disease 2002, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved.[iovs.arvojournals.org]
  • […] statement(s) immediately above Non pharmacological Do not attempt to probe the lacrimal system during acute infection (risk of spreading infection) (GRADE*: Level of evidence low, Strength of recommendation strong) Pharmacological Topical antibiotic to prevent[college-optometrists.org]
  • The reason for this seems to be the insertion of the orbital septum on the posterior orbital crest preventing extension to the orbit [ 4 ].[jmedicalcasereports.biomedcentral.com]
  • If you or your child often gets tear duct infections, one way to prevent them is to drain the tear sac. Wash your hands, then hold a warm, wet washcloth over the tear sac.[healthline.com]

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