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Dacryocystitis - External and Internal Eye
See also in: Cellulitis DDx
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Dacryocystitis - External and Internal Eye

See also in: Cellulitis DDx
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Contributors: Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD, Lauren Patty Daskivich MD, MSHS
Other Resources UpToDate PubMed

Synopsis

This summary discusses dacryocystitis in adults and children. Dacryocystitis in neonates is addressed separately.

Dacryocystitis refers to inflammation of the lacrimal sac, usually related to obstruction of the nasolacrimal duct. It may be acute or chronic. The most common cause of dacryocystitis is lacrimal duct stenosis or blockage with stagnation of lacrimal excretions and resultant infection. The most commonly identified bacterial isolates are species of staphylococci and streptococci, but gram-negative organisms, such as Haemophilus and Pseudomonas, and anaerobes may also cause the condition.

Acute dacryocystitis usually presents with the sudden onset of pain, swelling, and erythema at the medial canthal region. Chronic dacryocystitis most commonly manifests as the insidious onset of epiphora (excessive tearing). In the vast majority of cases, the site of obstruction is nasal rather than ocular (nasal tumors or foreign bodies, congenital malformations, inflamed nasal mucosa, post-traumatic anatomic abnormalities, etc). Other conditions and treatments that may predispose to lacrimal outflow obstruction include chemotherapy, radiation, lymphoma, granulomatosis with polyangiitis, sarcoidosis, and cicatricial pemphigoid.

Acute dacryocystitis may lead to formation of a lacrimal sac abscess (which can rupture and drain through the skin), conjunctivitis, preseptal cellulitis, and even spread of the infection to the orbit with subsequent orbital cellulitis. Treatment is with topical and systemic antibiotics acutely; chronic disease often requires surgery. In adults, dacryocystitis is more common in middle-aged to older women, as the occurrence is more prevalent with increasing age. It may occur less frequently in individuals of African descent due to slight anatomical differences.

Codes

ICD10CM:
H04.309 – Unspecified dacryocystitis of unspecified lacrimal passage

SNOMEDCT:
85777005 – Dacryocystitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 08/20/2019
Last Updated: 08/26/2019
Copyright © 2019 VisualDx®. All rights reserved.
Dacryocystitis - External and Internal Eye
See also in: Cellulitis DDx
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Dacryocystitis : Eye pain, Erythema, Eyelid edema, Inferior eyelid, Medial canthus, Periorbital edema, Lacrimal gland enlarged, Excessive tearing, Mucopurulent eye discharge
Clinical image of Dacryocystitis
Copyright © 2019 VisualDx®. All rights reserved.