Dacryocystitis and Dacryoadenitis

Dacryocystitis and Dacryoadenitis is a topic covered in the 5-Minute Emergency Consult.

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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
  • Dacryocystitis is a suppurative infection involving an obstructed lacrimal duct and sac

Epidemiology

Dacryoadenitis is an uncommon disorder more commonly seen on the left:
  • Acquired:
    • Uncommon
Dacryocystitis is a more common disorder most often occurring in adult females >30 yr old but may be seen in infants, usually shortly after birth
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 cellulites
  • 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


Etiology—Dacryocystitis
  • Under normal conditions, tears drain via pumping action at the lacrimal duct, moving tears to lacrimal sac and then into middle turbinate/sinuses
  • Symptoms begin when duct to lacrimal sac becomes partially or completely obstructed:
    • 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
    • Stasis in this conduit results in overgrowth of bacteria and infection
    • 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
  • In congenital form, presentation occurs in infancy as a result of dacryocystoceles, or in the newborn due to retained amniotic fluid
  • High morbidity and mortality associated with this form:
    • Caused by systemic spread of infectious process or bacterial overgrowth in a partially obstructed gland
  • The most common organism is Streptococcus pneumoniae

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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
  • Dacryocystitis is a suppurative infection involving an obstructed lacrimal duct and sac

Epidemiology

Dacryoadenitis is an uncommon disorder more commonly seen on the left:
  • Acquired:
    • Uncommon
Dacryocystitis is a more common disorder most often occurring in adult females >30 yr old but may be seen in infants, usually shortly after birth
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 cellulites
  • 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


Etiology—Dacryocystitis
  • Under normal conditions, tears drain via pumping action at the lacrimal duct, moving tears to lacrimal sac and then into middle turbinate/sinuses
  • Symptoms begin when duct to lacrimal sac becomes partially or completely obstructed:
    • 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
    • Stasis in this conduit results in overgrowth of bacteria and infection
    • 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
  • In congenital form, presentation occurs in infancy as a result of dacryocystoceles, or in the newborn due to retained amniotic fluid
  • High morbidity and mortality associated with this form:
    • Caused by systemic spread of infectious process or bacterial overgrowth in a partially obstructed gland
  • The most common organism is Streptococcus pneumoniae

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