Dacryocystitis and Dacryoadenitis
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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
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
- Bacteria most common cause in adults:
- 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
- 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:
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
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
- Bacteria most common cause in adults:
- 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
- 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:
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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