Dacryocystitis And Dacryoadenitis

Basics

Description

  • Dacryoadenitis and dacryocystitis are inflammatory conditions affecting the lacrimal system of the eye:
    • Dacryoadenitis is inflammation or infection of the lacrimal gland from which tears are secreted
    • Dacryocystitis is an infection within the lacrimal drainage system
  • Dacryoadenitis may be a primarily inflammatory condition or an infectious process resulting from contiguous spread from a local source or systemic infection
  • Acute dacryocystitis is a suppurative infection involving an obstructed lacrimal duct and sac
  • Chronic dacryocystitis causes tearing and matting of the lashes and mucoid discharge can be expressed from the sac

Epidemiology

  • Acute dacryoadenitis is an uncommon disorder usually seen in children as a complication of viral infection, but can be due to bacterial or fungal infection
  • Chronic dacryoadenitis (inflammation for longer than 1 mo) is more common in adults
  • Dacryocystitis is a more common disorder most often occurring in infants shortly after birth; less commonly seen in adults, usually women >40 yr old due to hormonal changes resulting in nasolacrimal duct narrowing

Etiology—Dacryoadenitis

  • Most commonly caused by systemic inflammatory conditions:
    • Autoimmune diseases
    • Sjögren syndrome
    • Sarcoidosis
    • Crohn disease
    • Tumor
  • Infectious causes may be primary or may occur secondary to contiguous spread from bacterial conjunctivitis or periorbital cellulitis
  • Acute, suppurative:
    • Bacteria most common cause in adults:
      • Staphylococcus aureus
      • Streptococci
      • Haemophilus influenzae
      • Chlamydia trachomatis
      • Neisseria gonorrhoeae
  • Chronic dacryoadenitis:
    • Nasal flora > ocular flora

Pediatric Considerations

  • Viruses most common cause in children:
    • Epstein–Barr virus
    • Mumps
    • Adenovirus
    • Cytomegalovirus
    • Herpes simplex virus
    • Varicella-zoster virus
  • Slowly enlarging mass may be dermoid cyst

Etiology–Dacryocystitis

  • Tears drain from the eye through the superior and inferior puncta, and into the lacrimal sac via 2 canals. Blinking results in the sac opening and closing causing a pumping action to move tears into the nasolacrimal duct and into the nose
  • Symptoms begin when the nasolacrimal duct becomes obstructed. Initially this results in epiphora (excess tearing). Eventually the structure can become infected due to stasis:
    • In acquired form, chronic inflammation related to ethmoid sinusitis is a commonly implicated cause but many nasal and systemic inflammatory conditions have been correlated with this process:
      • May also occur secondary to trauma, a dacryolith, after nasal or sinus surgery, or by any local process that might obstruct flow
    • Infection may be recurrent and may become chronic:
      • Most common bacteria: Sinus > ocular flora
      • S. aureus is the most common organism, followed by S. epidermidis, pneumococcus, and Pseudomonas aeruginosa

Complications may include formation of draining fistulae, recurrent conjunctivitis, and even abscesses or orbital cellulitis

Pediatric Considerations

  • Presentation most often occurs in infancy as a result of congenital nasolacrimal duct obstruction
  • Dacryocystocele is the 2nd most common cause of congenital lacrimal obstruction, and likely results from a proximal and distal obstruction of the lacrimal drainage system
  • Infected congenital dacryocystocele can be complicated with cellulitis, septicemia, meningitis, and brain abscess. Larger cysts in the nasal canal can cause respiratory distress and require prompt surgical intervention

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