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Dacryocystitis
Findings
- Nasolacrimal duct obstruction (NLDO)
- Pain, redness, and swelling over the medial canthus and the area overlying the lacrimal sac
- Tears, discharge, purulent material from puncta (especially with slight pressure with a cotton swab on the nasal part of the lower eyelid)
- +/- fever
Treatment
- Augmentin 1g 2x/d for 7 to 10 days
- In case of penicillin allergy: alternatively Cefuroxim 500mg 2x/d for 7 days
- In cases of abscess formation and pronounced findings: consider incision (caution: risk of fistula formation), consider endonasal dacryocystorhinostomy à chaud (depending on clinic: ENT consultation)
- In the case of spontaneous perforation through the skin
- Irrigation of the wound cavity with a Braunol-sodium chloride mixture and insertion of a mesh
- Daily wound checks until no more pus is formed
- After healing of dacryocystitis with persistent and impairing epiphora
- Evaluation of endonasal dacryocystorhinostomy (DCR) for suspected tear duct obstruction
- Caution: Do not perform tear duct irrigation during acute dacryocystitis, only after healing
- In case of suspected orbital cellulitis: facial bone CT and intravenous antibiotic therapy
Congenital Dacryocystitis
Findings
- Congenital nasolacrimal duct obstruction (NLDO)
- Typically observed earliest 2-4 weeks after birth
- Eyelids with crusts
- Redness in the area of the medial canthus
- Slightly increased tear lake
- +/- maceration of the eyelid skin
Treatment
- Lacrimal sac massage + Floxal (ofloxacin) gtt 3x/d for acute flares
- CAUTION: Tobrex gtt only for children > 1 year old
- If no improvement, consider lacrimal probing between 3-6 months of age
Sources
- EyeWiki Dacryocystitis
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)