Lacrimal Infections

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

Lacrimal

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 result from such a blockage

Patient with chronic, recurrent dacryocystitis

numerous etiologies, all cause nasolacrimal duct obstruction with obstruction of drainage from lacrimal sac to nose
- chronic tear stasis causes 2^o 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

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