Lacrimal Infections
DACRYOCYSTITIS
Epidemiology and Etiology
• Age: Most common in older adults but can be seen at any age
• Gender: More common in females
• Etiology: Nasolacrimal obstruction from various causes with stasis of fluid in the lacrimal sac and eventual infection
History
• Some may have acute onset of pain and swelling over the lacrimal sac. Others may have a history of chronic tearing with chronic mucous discharge and a tender lump over the lacrimal sac.
• There may be a prolonged history of a chronic conjunctivitis.
Examination
• Tenderness over the lacrimal sac is the most common finding.
• The lacrimal sac may be enlarged with significant swelling, or it may be relatively small (Fig. 9-1A). Similarly, the amount of periorbital swelling varies with the severity of the infection.
• Orbital cellulitis must be considered if the infection is severe (Fig. 9-1B).
• Patients with a low-grade chronic infection may have mucus/pus expressible through the canaliculi with pressure over the lacrimal sac. The conjunctiva may be injected.
• Probing and irrigation should not be done in the setting of an infection.
Special Considerations
• If a patient complains of blood expressed from the lacrimal system, a lacrimal sac tumor must be considered and imaging done. Infections can give bloody discharge as well.
Differential Diagnosis
• Lacrimal sac tumor
Laboratory Tests
• Culture and sensitivity of any material expressed or drained from the lacrimal sac
Imaging
• Computed tomographic scanning or magnetic resonance imaging may be needed if a lacrimal sac tumor is suspected.
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