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Dacryocystitis
From Wikipedia, the free encyclopedia
Dacryocystitis is an inflammation of the nasolacrimal sac, frequently caused by nasolacrimal
duct obstruction or infection. The term derives from the Greek dákryon (tear),[1] cyst (sac), and itis (inflammation). It causes pain, redness, and swelling over the inner aspect of the lower eyelid
and epiphora. When nasolacrimal duct obstruction is secondary to a congenital barrier it is
referred to as dacrocystoceles. It is most commonly caused by Staphylococcus aureus and
Streptococcus pneumoniae.[2] The most common complication is corneal ulceration, frequently in
association with S. pneumoniae.[2] The mainstays of treatment are oral antibiotics, warm
compresses, and relief of nasolacrimal duct obstruction by dacryocystorhinostomy.[2]
Clinical features
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Pain, swelling, redness over the lacrimal sac at medial canthus
Tearing, crusting, fever
Digital pressure over the lacrimal sac may extrude pus through the punctum
In chronic cases, tearing may be the only symptom
The lacrimal excretory system is prone to infection and inflammation for various reasons. This
mucous membrane-lined tract is contiguous with 2 surfaces (Conjunctival and nasal mucosal)
that are normally colonized with bacteria. The functional purpose of the lacrimal excretory system
is to drain tears from the eye into the nasal cavity. Stagnation of tears in a pathologically closed
lacrimal drainage system can result in dacryocystitis.
Acquired dacryocystitis can be acute or chronic.[1] Acute dacryocystitis is heralded by the sudden
onset of pain and redness in the medial canthal region. An insidious onset of epiphora is
characteristic of chronic inflammation or infection of the lacrimal sac.
See the image below.
Acute dacryocystitis.
A special form of inflammation of the lacrimal sac is that of congenital dacryocystitis, the
pathophysiology of which is intimately related to the lacrimal excretory system embryogenesis.
Dacryocystitis has long been noted to occur more frequently on the left side than on the right
side. In many instances, the nasolacrimal duct and lacrimal fossa formed a greater angle on the
right side than on the left side.
Medical Care
The treatment of dacryocystitis depends upon the clinical manifestations of the disease.
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Acute dacryocystitis with orbital cellulites necessitates hospitalization with intravenous
(IV) antibiotics.
o Appropriate neuroimaging studies should be obtained, and surgical exploration
and drainage should be performed for focal collections of pus.
o IV empiric antimicrobial therapy for penicillin-resistant Staphylococcus (nafcillin
or cloxacillin) should be initiated immediately.
o Blood cultures and cultures of the lacrimal secretions should be obtained prior to
antibiotic therapy.
o Treatment with warm compresses may aid in resolution of the disease.
o Impending perforation should be treated with a stab incision of the skin.
Purulent infection of the lacrimal sac and skin should be treated similarly. Hospitalization
is not mandatory unless the patient's condition appears serious.
o Treatment with oral antibiotics (e.g., Augmentin) is appropriate.
o Cultures of the lacrimal fluid should be obtained. The presence of a lacrimal sac
mucocele in adults’ mandates treatment even if asymptomatic.
o The treatment of choice is a dacryocystorhinostomy whether the patient is
symptomatic or not. Probing should not be performed because mucocele often
are not sterile and probing may incite cellulites.
Patients with chronic dacryocystitis caused by a partial or intermittent nasolacrimal duct
obstruction may benefit from topical steroid drop treatment.
Congenital chronic dacryocystitis may resolve with lacrimal sac massage, warm
compresses, and topical and/or oral antibiotics.
Treatment
Antibiotics that can be taken by mouth are the standard treatment for tear duct infection.
Antibiotics clear up acute infections quickly and can ease symptoms of chronic infections. Most
cases of acute tear duct infection clear up quickly with treatment. In some cases, antibiotic
ointment or eye drops may be prescribed. Do not attempt to apply an over-the-counter antibiotic
ointment to the eye or the area around the eye, since over-the-counter ointments are not made
for use in the eye and could have irritating ingredients.
If the infection does not respond to antibiotics, or if infections keep returning, minor surgery may
be needed. There are several types of surgical treatments for tear duct infections:
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Surgical probing of the tear duct, in which a thin wire is guided through the tear duct to
clear out any blockage. This is the most common treatment for recurring infections in
infants.
A procedure called dacryocystorhinostomy, in which the narrowed or blocked duct is
expanded. This usually requires removal of bone that has caused the duct's narrowing.
This surgery commonly is done with the aid of a laser.
Removing all or part of the lacrimal sac.
Home Remedies For Dacryocystitis
Dacryocystitis is a type of eye infection, which takes place the tear duct. It causes pain, swelling
and redness in the inner area of the lower eyelid. The infection is diagnosed as an after effect of
nasolacrimal obstruction. Symptoms of the infection include pain and redness in the inner corner
of the eyes. Irritation in the eyes may lead to constant itching as well. The treatment for
dacryocystitis includes warm compresses and the use of antibiotics. If you are looking for some
quick natural treatments for curbing the infection, the tips given below will come handy.
Natural Remedies For Dacryocystitis
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Take a clean cloth and dip in it lukewarm water. Now, gently press the damp cloth on the
swollen lump in your eyes. This will help get rid of the itchiness.
Herbal eyewashes help a great deal in reducing the irritation caused by eye infection.
One teaspoon dried ‘eyebright’ herb should be soaked in 1 pint of boiling water. After it
cools, strain it to get the essence of the herb. Now, it is ready to be used as eyewash.
Make a warm compress of chamomile and rose oil and treat your infected eyes with it.
Aloe vera is a herb with soothing effect. To soothe your infected eyes, soak a cloth in
aloe vera juice and place it over your eyes.
Placing cold bread over your eyes can also help in lessening the itchiness and
inflammation.
Eyewash that proves effective in treating Dacryocystitis is elderberry blossom tea. Make a
decoction by brewing 1 teaspoon of dried elderberry blossoms in half a cup of water.
Cool it and use it as eyewash.
Moisten your eyes with artificial tears or glycerin and flush out the foreign body. Then,
treat the clean eyes with aloe-vera eyewash.
Boil two cups of water and add three tablespoons honey. Allow it to cool and then treat
you infected eyes with the eyewash.
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