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Acute dacryocystitis


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Acute dacryocystitis

  2. 2.  Definition  Etiology  Predisposing factors  Causative organisms  Clinical picture  Complications  Treatment
  3. 3. Acute Dacryocystitis is an acute suppurative inflammation of the lacrimal sac, characterised by the presence of a painful swelling in the region of sac.
  4. 4. 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.
  5. 5.  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
  6. 6. Commonly involved are;  Streptococcus haemolyticus  Pneumococcus  Staphylococcus
  7. 7. It can be divided into 3 stages;  Stage of cellulitis  Stage of lacrimal abscess  Stage of fistula formation
  8. 8. 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
  9. 9.  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
  10. 10.  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
  11. 11.  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
  12. 12. 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
  13. 13. 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
  14. 14. During external lacrimal fistula;  After controlling the acute infection with systemic antibiotics, fistulectomy along with DCT or DCR operation should be performed
  15. 15.  A K KhuranaTextbook of Ophthalmology, 5th edition  Parsons’Textbook of Ophthalmology, 22nd edition.
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