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
Etiology—Dacryoadenitis
  • 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

Pediatric Considerations
  • Viruses most common cause in children:
    • Mumps
    • Measles
    • Epstein–Barr virus
    • Cytomegalovirus
    • Coxsackievirus
    • 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
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
  • 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.

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