Lacrimal (Tear System)
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Dacryoadenitis
- Symptoms include pain, tenderness and swelling of the lateral aspect of the eyelid
- May occur with systemic diseases such as Sjogren’s, sarcoidosis, syphilis, TB, lymphoma, and benign lymphoid hyperplasia
- May occur in patients with mums, EBV, zoster
Canaliculitis
- Symptoms include pain, swelling, tenderness of the INNER canthus of the eye
- Etiology is usually actinomycetes
- May be treated with Penicillin irrigation
- Actinomycetes is also sensitive to gtts
Dacryocystitis
- Symptoms: acute onset, tearing (from nasolacrimal duct obstruction), redness, purulent discharge, tender swollen lacrimal sac
- An infection within the “tear duct” causes a painful swelling in the inner corner of the eyelids.
- If the tearing causes severe symptoms, surgery can be performed to create a new tear duct. This operation is called “dacryocystorhinostomy.” (see below). Small silicone tubes my be placed in the tear system to keep the new tear duct open while healing occurs. Surgical elimination of the obstruction by creating a new tear duct is necessary to eliminate the tearing and infection that can lead to from such a blockage
Acute Dacryocystitis
several etiologies, all cause nasolacrimal duct obstruction with obstruction of drainage from lacrimal sac to nose
- chronic tear stasis causes 2o infxn
- edema, erythema below medial canthal tendon w/lac sac distention
- +/- pain
- rule out ethmoidal sinusitis, don’t probe
Treatment
- warm compresses
- oral/IV abx (Keflex, Augmentin), topical only limited value
- Incision Drainage localized abscess
Complications
- mucocele, chronic conjunctivitis, orbital cellulitis
- most need DCR after acute infection subsides
Chronic Dacryocystitis
- distended lac sac with minimal inflammation suppurative discharge from punctum c/w nasolacrimal duct obstruction
- probe/irrigate upper system only
- dacryoliths from Actinomyces, Candida, topical meds, can cause lacrimal colic if impacted in NLD
Treatment
- usually needs DCR for resolution
