Lacrimal (Tear System)
Dacryoadenitis is inflammation of the tear-producing lacrimal gland. This condition may occur with systemic diseases such as Sjogren’s, sarcoidosis, syphilis, TB, lymphoma, and benign lymphoid hyperplasia and may occur in patients with mums, EBV, zoster. Symptoms include pain, tenderness and swelling of the lateral aspect of the eyelid. Complications from dacryoadenitis are rare, although a lacrimal gland abscess may develop. The infection may lead to preseptal or orbital cellulitis as well. It is typically treated with systemic broad spectrum antibiotics and abscess drainage when necessary.
Each eye has two canaliculi, one for the upper eyelid and one for the lower. The canaliculus (plural, canaliculi) is a short channel near the inner corner of the eyelid through which tears drain into the tear sac. Canaliculitis is an inflammation, usually caused by infection of the canaliculus. Symptoms include pain, swelling, tenderness of the inner canthus of the eye. It may be treated with Penicillin irrigation. Typically this infection impacts those individuals over 40 years of age. It can turn into a chronic inflammation of the canalicular system and can remain undiagnosed for a long period of time because it is rare and has a variable presentation.
Dacryocystitis is an infection of the nasolacrimal sac and sometimes coincides with a blockage of the nasolacrimal duct. It can be acute or chronic and congenital or acquired. Medial canthal swelling of dacryocystitis is usually located below the medial canthal tendon. Symptoms include acute onset, tearing from nasolacrimal duct obstruction, redness, discharge, and tender and swollen lacrimal sac. If the tearing causes severe symptoms, surgery can be performed to create a new tear duct: silicone tubes are placed in the tear system to keep the new tear duct open while healing occurs.
Acute dacryocystitis is characterized by a nasolacrimal duct obstruction impacting drainage from the lacrimal sac to the nose:
- Chronic tear stasis causes a secondary infection
- Edema, erythema below medial canthal tendon with lacrimal sac distention
- +/- pain
- rule out ethmoidal sinusitis, don’t probe
Treatment may include:
- Warm compresses
- Oral/IV antibiotics such as Keflex, Augmentin (topical antibiotics have limited value)
- Incision drainage localized abscess
- Mucocele, chronic conjunctivitis, orbital cellulitis
- Most need DCR after acute infection subsides
Chronic dacryocystitis is characterized by a distended lacrimal sac with minimal inflammation and suppurative discharge from the punctum:
- Important to probe/irrigate upper system only
- Acryoliths from Actinomyces, Candida, and topical medication can cause lacrimal colic if impacted in NLD.
- Usually needs DCR for resolution