Kevin B. H. Vo , Mark J. Lucarelli & Suzanne W. van Landingham
This report presents two cases of epidemic keratoconjunctivitis (EKC)-associated dacryocystitis. Both patients presented with preseptal edema. Orbital computed tomography (CT) scans were performed out of concern for orbital cellulitis and revealed soft tissue edema involving the preseptal aspect of the eyelids and also the lacrimal sac. Both patients were initially diagnosed with bacterial preseptal cellulitis with dacryocystitis and admitted for treatment with intravenous antibiotics. After no improvement on antibiotics, both patients were noted to have exam findings consistent with viral conjunctivitis, and one patient had a positive conjunctival swab for adenovirus. Both patients were subsequently treated with topical steroids, and symptoms improved. EKC has previously been identified as a cause of acquired nasolacrimal duct obstruction and canalicular stenosis, and acute inflammation of the lacrimal apparatus may explain this link. Dacryocystitis may also be contributory to the copious tearing seen in patients with epidemic keratoconjunctivitis.
Farzad Pakdel, Mohammad Soleimani, Abolfazl Kasaei, Kambiz Ameli, Niloofar Pirmarzdashti, Ali Sadeghi Tari, Mehrbod Ghasempour & Ali Banafsheafshan
We aimed to show the outcome of very early endoscopic dacryocystorhinostomy (VE-EDCR) in a routine pool of patients with acute dacryocystitis (AD) and abscess formation compared with the standard late external dacryocystorhinostomy L-ExDCR.
This was a prospective nonrandomized comparative study conducted from June 2013 to March 2016. Patients with AD and abscess formation were referred to our oculo-facial clinic in a university-based hospital. All patients received systemic antibiotics and were assigned to either of treatment groups. Patients in group 1 underwent late external transcutaneous DCR (L-ExDCR) and group 2 underwent EDCR within 3 days after first visit, named VE-EDCR. Primary outcome measure was success of surgery.
Forty-one eyes of 41 patients with acute suppurative AD, were included from June 2013 to March 2016. Twenty-two patients underwent VE-EDCR and 19 underwent L-ExDCR. Mean age of patients was 43.41 (SD = 19.84, range 14–98) years. Mean follow-up was 14 (SD = 2.4) months. Anatomic, functional, and overall success in L-ExDCR and VE-EDCR groups were (89.5 and 86.4%, p = 0.99) (89.5% and 86.4%, p = 0.99) (89.5% and 81.8%, p = 0.66) respectively. Mean duration of cellulitis in VE-EDCR and L-ExDCR were 8.00 (SD = 4.63) and 16.11 (SD = 11.58) days, respectively (p = 0.027). No remarkable adverse event was found.
Success of very early endonasal endoscopic DCR is comparable with the traditional late external DCR. Duration of cellulitis is shorter in VE-EDCR. This therapeutic approach can be considered in patients with acute suppurative dacryocystitis.
Marianne Juul-Dam, Clara Laursen, Linda Wiboe, Birgitte Hertz, Jesper Bille & Kristian Næser
Retrobulbar orbital abscess in children is a rare condition, and diagnosis and management can be challenging. We report the case of a 5-week-old male infant with retrobulbar orbital abscess secondary to acute dacryocystitis developed from a dacryocystocele. The patient presented with respiratory difficulty, sepsis and progressive clinical findings suggestive of post-septal cellulitis. He was successfully treated with endonasal incision of subturbinate dacryocystoceles followed by probing of the lacrimal ducts. Congenital dacryocystocele must be considered a differential diagnosis in infants with respiratory difficulty and may develop into a vision- and life-threatening condition requiring immediate intervention.
Vasanthapuram, Varshitha Hemanth; Ali, Mohammad Javed
The common ocular manifestations of CHARGE syndrome include colobomatous defects in the eye, strabismus, nystagmus, and micropthalmia. Lacrimal drainage anomalies have been rarely reported and to the best of the authors’ knowledge, only 5 such cases have been reported earlier. The present case describes CHARGE syndrome associated with bilateral complex congenital nasolacrimal duct obstruction with multiple prior attacks of acute dacryocystitis and left lower punctal agenesis, successfully managed with a right-sided dacryocystorhinostomy and awaiting a left dacryocystorhinostomy.
Lacrimal drainage anomalies in CHARGE syndrome include complex CNLDO, punctal agenesis, and acute dacryocystitis.
Amir Tengku-Fatishah, Baharudin Abdullah, Nadarajah Sanjeevan, Abdul Hamid Nurul-Shuhada, Tuan Sharif Sharifah-Emilia, Juhara Haron, Ismail Shatriah
A dermoid cyst is a choristoma that originates from the ectoderm and mesoderm that usually entraps at suture lines.1, 2 An orbital dermoid cyst typically presents as an egg-shaped mass under the skin adjacent to the bones of the eye socket. The most common site for a dermoid cyst is at the frontozygomatic suture, which is situated close to the eyebrow.
Dermoid cysts that are situated close to the lacrimal drainage passage are extremely uncommon. We report a toddler who presented with recurrent episodes of acute dacryocystitis as a consequence of an infraorbital dermoid cyst and discuss the options for managing this challenging case.
Singh, Swati; Ali, Mohammad Javed
Purpose: To provide a systematic review of the literature on congenital dacryocystoceles (CDCs) and summarize their presentations, investigations, management, and outcomes.
Methods: The authors performed a PubMed search of all articles published in English on CDCs. Data captured include demographics, clinical presentations, investigations, management modalities, complications, and outcomes. Fourteen major series (10 or more than 10 cases) and 89 isolated case reports/series on CDCs with a collective patient pool of 1,063 were studied in detail. Specific emphasis was laid on addressing the controversial issues including initial conservative versus surgical management and the role of endoscopic evaluation.
Results: Numerous terminologies have been used to describe CDC. Congenital dacryocystoceles are rare variants of congenital nasolacrimal duct obstructions and comprise of 0.1% to 0.3% of all such cases. There is a female predilection (64.2%, 683/1,063) and the mean age at presentation is at 7 days of birth. Initial conservative treatment can be a viable option in the absence of an acute dacryocystitis or a respiratory distress. Endoscopy-assisted probing appears to have better outcomes as compared with the in-office probing. Congenital dacryocystoceles with acute dacryocystitis are preferably managed with intravenous antibiotics and an early probing under endoscopy guidance to avoid missing intranasal cysts. Marsupialization is the preferred technique in the management of intranasal cysts. Silicone intubation was rarely used and has no definitive indications. Dacryocystorhinostomy is very rarely needed in the management of CDC.
Conclusions: Congenital dacryocystocele is a commonly accepted term and its use should be advocated to enhance uniformity in reporting. Endoscopic evaluation of CDC is useful in the diagnosis and treatment of associated intranasal cysts and enhances the rates of successful outcomes.
Stella Y. Chung, Leon Rafailov, Roger E. Turbin & Paul D. Langer
Purpose: Recent studies suggest an increasing incidence of gram-negative bacteria and methicillin-resistant Staphylococcus aureus in dacryocystitis. Since patients are often treated empirically without culture data, a changing microbiologic profile will markedly affect the success of oral treatment. To provide current guidelines for the treatment of this common condition, we investigated the microbiology and antibiogram of dacryocystitis seen at our institution.
Methods: The charts of all patients presenting with acute and/or chronic dacryocystitis in University Hospital, Newark, from 2007 to 2015 were reviewed. Patient demographics, culture isolates, and in vitro antimicrobial susceptibility data were collected. Additional sensitivity data were obtained from the Sanford Guide to Antimicrobial Therapy.
Results: A total of 137 patients were included in the study. Of 205 samples collected, S. aureus was the most commonly isolated organism (46 of 156, 30%) followed by Pseudomonas species (19 of 156, 12%) and Propionibacterium acnes (15 of 156, 10%). Based on sensitivity data, the two oral antibiotics that would have been most effective in this population were levofloxacin and amoxicillin/clavulanate; however, even these antibiotics would have encountered at least one resistant organism in 16% and 32% of patients, and potentially in another 15% and 8% of patients, respectively.
Conclusions: Given the broad range of causative organisms, routine treatment of dacryocystitis with any specific antibiotic may fail in up to one-third of patients. Obtaining a culture at the time empiric antibiotic treatment is initiated can prove extremely valuable when treating patients with dacryocystitis.
Jingwen Ding, Hua Sun, Yue Xin, Dongmei Li
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. It tends to present with distant metastasis at diagnosis, most frequently in the lung, lymph nodes, and bone. The lacrimal drainage system is an unusual site for metastatic cancer. We herein report a case of lacrimal sac metastasis from HCC mimicking acute dacryocystitis.
Nicholas A. Moore, MD; Rao V. Chundury, MD, MBA
A 7-day-old healthy infant, born at 38 weeks by spontaneous vaginal delivery without complications, presented to the emergency department with a new-onset enlarging erythematous mass overlying her right medial lower eyelid (Figure 1). The infant’s mother reported a small blue bump present at birth near the medial canthus. Otherwise, the infant was stable, nontoxic appearing on examination, and feeding well. The patient was admitted for broad-spectrum intravenous vancomycin and piperacillin/tazobactam for treatment of acute dacryocystitis with overlying preseptal cellulitis. The admitting team collected a complete blood cell count, basic metabolic panel, and blood cultures and performed a lumbar puncture for cerebrospinal fluid analysis, the results of which were within normal limits. A maxillofacial computed tomographic scan was also obtained by the admitting service owing to concerns over displacement of the right globe (Figure 1). The patient continued treatment with intravenous antibiotics and on day 2 of admission, ophthalmology was consulted. A bedside beveled percutaneous needle drainage was performed with a 25-gauge syringe. The lacrimal sac was decompressed and 3 mL of purulent discharge was aspirated. By day 3 of admission, the edema and preseptal cellulitis had improved.
Lin Lin, Li Yang†, Xiuming Jin, Yingying Zhao and Fangli Fan
Treatment of lacrimal sac abscess of the traditional surgical approach may result in complications from cutaneous fistula formation, damage the sac, cause skin scarring and even have the potential for inducing cicatricial ectropion. We designed a new treatment scheme that is expected to achieve internal drainage with the use of lacrimal probe and crawford silicon tube.
A prospective study was performed for the management of lacrimal sac abscesses. All suitable patients from January 2011 to June 2014 were managed by lacrimal probe and crawford tube insertion. Postoperatively, patients received 0.5% Levofloxacin eye drops four times per day and oral Levofloxacin tablets 0.5 g once per day for four days. Follow-up times were for more than three months after removing the Crawford tube. The condition of the lacrimal sac and the patient’s symptoms were carefully evaluated.
Fourteen patients suffering from lacrimal sac abscesses were included in this study. A history of chronic dacryocystitis was found in six patients, after acute dacryocystitis was found in three patients, and nasolacrimal occlusion with epiphora was found in other five patients. Resolution of signs and symptoms of lacrimal sac abscesses in all fourteen patients. No recurrence of lacrimal sac abscesses occurred during the median follow up period of 20.9 ± 7.8 months (range 6–36 months). Epiphora reoccurred in four patients.
Lacrimal probe and crawford silicon tube is successful as a procedure of choice for lacrimal sac abscesses. The insertion of a Crawford tube also offers potential advantages over standard treatment with the lack of recurrence of dacryocystitis or infection in post-surgical patients.