Dacryocystitis and Dacryoadenitis

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

• Acquired:
  • Uncommon

• Most commonly caused by systemic inflammatory conditions:
  • Autoimmune diseases
  • Sjögren syndrome
  • Sarcoidosis
  • Crohn's 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
    • Chlamydia trachomatis
    • Neisseria gonorrhea
• Chronic dacryoadenitis:
  • Nasal flora > ocular flora

• Viruses most common cause in children:
  • Mumps
  • Measles
  • Epstein–Barr virus
  • Cytomegalovirus
  • Coxsackievirus
  • Varicella-zoster virus
• Slowly enlarging mass may be dermoid

• 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

• In congenital form, presentation occurs in infancy as a result of dacryocystoceles
• 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 pneumonia.