acute dacryocystitis
TRANSCRIPT
ANUDEEPA . M429831/8/15Faculty in charge:Dr Ananth Bhandary
ACUTE DACRYOCYSTITIS
CONTENTS
Definition Etiology Predisposing factors Causative organisms Clinical picture Complications Treatment
ACUTE DACRYOCYSTITIS
Acute Dacryocystitis is an acute suppurative inflammation of the lacrimal sac, characterised by the presence of a painful swelling in the region of sac.
ETIOLOGY
It may develop in two ways; As an acute exacerbation of chronic
dacryocystitis As an acute peridacryocystitis due to direct involvement from the neighbouring infected structures such as; paranasal sinuses,
surrounding bones, dental abscess or caries teeth in the
upper jaw.
PREDISPOSING FACTORS
Age: more common between 40-60 years Sex: predominantly seen in females probably due to camparatively narrow lumen of the
bony canal Heridity: plays an indirect role, it affects the
facial configuration and so also the length and
width of the bony canal Poor personal hygeine
CAUSATIVE ORGANISMS
Commonly involved are; Streptococcus haemolyticus Pneumococcus Staphylococcus
CLINICAL PICTURE
It can be divided into 3 stages; Stage of cellulitis Stage of lacrimal abscess Stage of fistula formation
STAGE OF CELLULITIS
It is characterised by; Painful swelling in the region of lacrimal
sac Swelling is red, hot, firm and tender Redness and oedema also spread to the
lids and cheeks Epiphora Constitutional symptoms such as fever,
malaise When treated resolution may occur at this
stage, if untreated self resolution is rare
STAGE OF LACRIMAL ABSCESS Continued inflammation causes occlusion of the canaliculi due to oedema The sac is filled with pus, distends and its anterior wall ruptures forming a pericystic swelling In this way a large fluctuant swelling, the lacrimal
abscess is formed It usually points below and to the outer side of the sac due the gravitation of pus and the presence of medial palpebral ligament in the upper part
LACRIMAL ABSCESS
STAGE OF FISTULA FORMATION When the lacrimal abscess is left
unattended, it discharges spontaneously, leaving an
external fistula below the medial palpebral
ligament Rarely, the abscess may open up into the
nasal cavity forming an internal fistula
EXTERNAL LACRIMAL FISTULA
COMPLICATIONS
Acute conjunctivitis Corneal abrasion which may be converted to corneal ulceration Lid abscess Osteomyelitis of lacrimal bone Orbital cellulitis Facial cellulitis and acute ethmoiditis Rarely cavernous sinus thrombosis and very
rarely generalised septicaemia may also develop
TREATMENT
During cellulitis stage; Systemic(ciprofloxacin or cephalosporin or
tetracycline or cotrimoxazole for 7 days) and topical antibiotics to control infection
Systemic anti inflammatory, analgesic drugs and
hot fomentation to relieve pain and swelling
During stage of lacrimal abscess; In addition to the above treatment when
pus starts pointing on the skin, it should be drained
with a small incision. The pus should be gently squeezed out,
the dressing should be done with betadine Later depending upon condition of the
lacrimal sac either DCT or DCR operation should
be carried out, otherwise recurrence will occur
During external lacrimal fistula; After controlling the acute infection with
systemic antibiotics, fistulectomy along with DCT
or DCR operation should be performed
REFERENCE
A K Khurana Textbook of Ophthalmology, 5th edition Parsons’ Textbook of Ophthalmology, 22nd
edition.
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