Dacryocystitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fatimo Biobaku M.B.B.S [2]
Overview
Anatomy of the Lacrimal System[1][2]
The lacrimal gland produces tears, and it secretes an approximate volume of 10mL in 24hrs. Tears flow across the eye, draining into the puncta, canaliculi, lacrimal sac, and lacrimal duct into the nasal cavity. The valves within the drainage system are unidirectional, allowing one-way flow of tears only.
Classification
Dacryocystitis may be classified as:[2]
- Acute- This is an acute inflammation of the lacrimal sac with tenderness and erythema of the overlying tissues.[3]
- Subacute
- Chronic- This may be the end stage of acute/subacute dacryocystitis, and dacryocystorhinostomy is commonly the definitive management when chronic or recurrent dacryocystitis occurs.[1]
Pathophysiology[4][5]
Dacryocystitis is an inflammation and infection of the lacrimal sac. Dacryocystitis usually occurs following partial/complete obstruction within the nasolacrimal duct or in the lacrimal sac, and it is the most common infection of the lacrimal apparatus. Nasolacrimal duct obstruction can occur in any age group, and it can be congenital or acquired. The lacrimal excretory system drain tears from the eyes into the nasal cavity, and its mucus membrane-lined tract is contiguous with the conjunctival and nasal mucosal surfaces which are normally colonized with bacteria. Following the obstruction of the nasolacrimal duct, stasis occurs with the accumulation of tears, desquamated cells, and mucoid secretions, creating an enabling environment for superimposed bacterial infection.
Nasolacrimal duct obstruction
- Congenital obstruction- This occurs in 3–6% of term infants. The nasal end of the duct is commonly affected, and it can be blocked by epithelial debris or an imperforate mucosal membrane resulting from incomplete canalization of the embryonic duct.
- Acquired obstruction- This can be primary or secondary.
- Primary acquired nasolacrimal duct obstruction- seen in idiopathic inflammatory stenosis.
- Secondary acquired nasolacrimal duct obstruction- occurs as a result of trauma, infection, inflammation, neoplasm, or mechanical obstruction.
Causes
Bacterial Causes[6]
The most common aerobic organisms
- Staphylococcus species like S. epidermidis, S. aureus.
- Streptococcus sp.
- Pseudomonas sp.
- Pneumococcal species
The most common anaerobic organisms:
- Peptostreptococcus sp.
- Propionibacterium sp.
- Prevotella sp.
- Fusobacterium species
The most common gram-negative bacteria
- Pseudomonas aeruginosa
- Klebsiella sp.[3]
- Escherichia coli
- H. influenza[1]
- Enterobacter sp.[7]
- Citrobacter sp.
Uncommon bacterial causes
- Neisseria sp.[3]
Fungal causes[6]- These are rare causes of dacrocystitis.
Parasitic causes- Parasites are not a common cause of dacryocystitis. Some parasites that have been documented to cause dacryocystitis include:
Viral causes
- Epstein-Barr virus (EBV)- Viruses such as the EBV are rare causes of dacrocystitis.[8]
Differential Diagnosis[6]
Swellings in the region of the medial epicanthi can occur in the absence of infection. The following conditions can mimic dacryocystitis:
- Dacryocystocele- Blockage of the nasolacrimal duct/sac results in the distension of the lacrimal sac. The distended, uninfected lacrimal sac is often referred to as a dacryocystocele or dacryocele.
- Malignant tumors of the lacrimal sac such as:
- Squamous cell carcinoma
- Adenoid cystic carcinoma
- Oncocytic carcinoma
- Epidermoid carcinoma
- Benign lesions affecting the lacrimal sac such as:
- Papilloma
- Dermoid cysts
- Mucoepidermoid cysts
- Adenoma
- Lymphoproliferative disorders
- Mesenchymal tumors- Mesenchymal tumors of the lacrimal sac is rare, and they include:
- Hemangioma
- Hemangiopericytoma
- Melanoma
- Fibroma
- Fibrous histiocytoma
- Neurilemmoma
- Plexiform neuroma
- Granulomatous diseases affecting the lacrimal sac- E.g Wegener's and sarcoid granulomatosis
- Secondary involvement of the lacrimal sac from cutaneous squamous cell carcinoma and basal cell carcinoma.
- Metastatic disease of the lacrimal sac- This is very rare.
Epidemiology and Demographics[6]
Age
Dacryocystitis has a bimodal age distribution, with greater incidence in neonates and individuals above 40years of age. The peak incidence for adults is usually between 60-70years.[5]
Sex
In neonatal dacryocystitis, there is no sex predilection. Dacryocystitis affecting adults commonly affect females more than males.
Race
Dacryocystitis is more prevalent in whites compared to blacks.
Geographical Distribution
Dacryocystitis is common in tropical countries like India, especially in people of lower socioeconomic status.[5]
Risk Factor[6]
Predisposing factors for dacryocystitis are often factors that result in the obstruction of the nasolacrimal duct/sac, and they include:
- Mucoceles
- Dacryolyths
- Enlarged turbinates
- Rhinitis
- Sinusitis
- Adenoids
- Foreign bodies
- Nasal septum deviation
- Nasal septum abscess
- Tumors
- Iatrogenic causes
- Trauma
Natural History, Complications, and Prognosis
Diagnosis
Treatment
Clincial Features
Diagnosis
References
- ↑ 1.0 1.1 1.2 1.3 Durand, Marlene (2015). "Chapter 118:Periocular infections". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 1432–1438. ISBN 978-1-4557-4801-3.
- ↑ 2.0 2.1 Jeffrey, Hurwitz (2014). "Chapter12.15:The Lacrimal Drainage System". Ophthalmology, Fourth Edition. Elsevier. pp. 1346–1351. ISBN 978-1-4557-5001-6.
- ↑ 3.0 3.1 3.2 Eshraghi B, Abdi P, Akbari M, Fard MA (2014). "Microbiologic spectrum of acute and chronic dacryocystitis". Int J Ophthalmol. 7 (5): 864–7. doi:10.3980/j.issn.2222-3959.2014.05.23. PMC 4206896. PMID 25349808.
- ↑ Bharathi MJ, Ramakrishnan R, Maneksha V, Shivakumar C, Nithya V, Mittal S (2008). "Comparative bacteriology of acute and chronic dacryocystitis". Eye (Lond). 22 (7): 953–60. doi:10.1038/sj.eye.6702918. PMID 17603466.
- ↑ 5.0 5.1 5.2 Wadgaonkar S.P., Patil P.A., Nikumbh D.B., Rathod S.S. and Sawat C.M. (2016). "Epidemiology of chronic dacryocystitis with special reference to socioeconomic status: A rural hospital study" (PDF). Indian Journal of Clinical and Experimental Ophthalmology. 2 (1): 52–56.
- ↑ 6.0 6.1 6.2 6.3 6.4 Asheim J, Spickler E (2005). "CT demonstration of dacryolithiasis complicated by dacryocystitis". AJNR Am J Neuroradiol. 26 (10): 2640–1. PMID 16286415.
- ↑ 7.0 7.1 Assefa Y, Moges F, Endris M, Zereay B, Amare B, Bekele D; et al. (2015). "Bacteriological profile and drug susceptibility patterns in dacryocystitis patients attending Gondar University Teaching Hospital, Northwest Ethiopia". BMC Ophthalmol. 15: 34. doi:10.1186/s12886-015-0016-0. PMC 4396718. PMID 25880996.
- ↑ 8.0 8.1 Ali MJ (2015). "Pediatric Acute Dacryocystitis". Ophthal Plast Reconstr Surg. 31 (5): 341–7. doi:10.1097/IOP.0000000000000472. PMID 25856337.
- ↑ Comez AT, Koklu A, Akcali A (2014). "Chronic dacryocystitis secondary to Stenotrophomonas maltophilia and Staphylococcus aureus mixed infection". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-203642. PMC 4069627. PMID 24951597.
- ↑ Borgman CJ (2014). "Proteus mirabilis and its role in dacryocystitis". Optom Vis Sci. 91 (9): e230–5. doi:10.1097/OPX.0000000000000347. PMID 25036545.
- ↑ Freitas DF, Lima IA, Curi CL, Jordão L, Zancopé-Oliveira RM, Valle AC; et al. (2014). "Acute dacryocystitis: another clinical manifestation of sporotrichosis". Mem Inst Oswaldo Cruz. 109 (2): 262–4. PMC 4015260. PMID 24810176.
- ↑ Halawa A, Yacoub G, Al Hassan M, Byrd RP, Roy TM (2008). "Dacryocystitis: an unusual form of Mucorales infection". J Ky Med Assoc. 106 (11): 520–4. PMID 19058477.
- ↑ Durdu M, Gökçe S, Bagirova M, Yalaz M, Allahverdiyev AM, Uzun S (2007). "Periocular involvement in cutaneous leishmaniasis". J Eur Acad Dermatol Venereol. 21 (2): 214–8. doi:10.1111/j.1468-3083.2006.01903.x. PMID 17243957.