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Table of contents
Lacrimal Infections

This section covers dacryoadenitis (inflammation of the lacrimal gland), canaliculitis (inflammation of the canaliculi), and dacryocystitis (inflammation of the lacrimal sac).


Dacryoadenitis

Dacryoadenitis is inflammation of the lacrimal glands


Pathology

  • Often idiopathic
  • Secondary causes include viral infections like mumps

Diagnostics

Presentation

  • Acutely painful upper lateral lid
  • Swollen lacrimal gland
  • Hypoglobus (medially)
  • Enophthalmos
  • S-shaped eyelid deformity

Investigations

Only if recurrent or suspicious

  • Orbital MRI/CT
  • Biopsy

Bilateral dacryoadenitis should raise suspicion of sarcoidosis


Management

  • Oral NSAIDs or steroids

Resolution can take months


Canaliculitis

Inflammation of the canaliculi


Pathology

  • Often caused by infection, most commonly by Actinomyces

Presentation

  • Unilateral epiphora and discharge

Management

  • Topical antibiotics and canaliculotomy

Canalicular repair following canalicular trauma is with a Mini Monoka tube for 3 months


Dacryocystitis

Inflammation of the lacrimal sac. It requires urgent management to prevent the spread of cellulitis.


Pathology

  • Caused by nasolacrimal duct obstruction, usually by Staphylococcus species

Presentation

A CT scan of a patient with dacryocystitis. By James Heilman, MD, CC BY-SA 4.0.

  • Presents acutely with epiphora and a tender lacrimal sac.

Management

Acute

  • Warm compress and oral antibiotics

Chronic/recurrent

  • Dacryocystorhinostomy (open connection between the nasolacrimal duct and middle nasal meatus)

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