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Acute dacryocystitis

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This is caused by inflammation of the lacrimal sac. It is often associated with obstruction of the 
nasolacrimal duct with watering of the eye. Infection are often due to streptococcus and 
staphylococcus.

Presentation:

  • Painful swelling at the nasal side of the lower lid. 
Examination:
  • Visual acuity is normal.
  • The swelling is tense and  tender to touch
  • In severe cases, the whole of the lower lid may be swollen due to superimposed cellulitis
Management:
  • Refer the patient to the ophthalmologists within 24 hours.
  • High dose systemic antibiotic is required either orally or by intravenous.
  • Incision of the swelling should be avoided as this can cause fistula formation
  • Most patient will require dacryocystorhninostomy (an artificial passage is created 

  • between the lacrimal sac and the nasal cavity to bypass the blockage)  when the 
    acute episode settle.
Figure 1.
This patient presented with a swellon and painful left lower lid. Note the location 
of the swelling which is diagnostic of acute dacryocystitis. High dose oral antibiotics
were given. When the swelling settled, a dacryorhinostomy was performed to 
prevent recurrence.

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Figure 2
Another patient with left acute dacryocystitis. Note the presence of 
concurrent conjunctivitis. Systemic antibiotic is the treatment of choice. 
Incision of the swelling should be avoided as it can lead to formation 
of fistula.

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