Acute dacryocystitis
 ..
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. |
|
| b |
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. |
Return
to swollen lids |
|