- Nasolacrimal Duct Obstruction
- Obstruction predisposes to tear stasis and infection
- Bacterial Infection occurs from contiguous spread from colonized Conjunctiva or nasal mucosa
- Acute Dacryocystitis
- Presents with pain and erythema at the medial canthus
- Chronic dacrocystis
- Chronic inflammation at the lacrimal sac results in epiphora
- Congenital Dacryocystitis
- Distinguish from the typical minor Lacrimal Duct Obstruction common to many newborns (relieved with massage at medial canthus)
- Associated with craniofacial abnormalities
- Risk of Orbital Cellulitis
- Infants
- Congenital Nasolacrimal Duct Obstruction
- Adults
- Chronic Rhinitis or Chronic Sinusitis
- Facial Trauma
- Maxillofacial tumor
- Eye Pain or irritation
- Epiphora (excessive tearing, spilling onto the face)
- Acute
- Conjunctival injection
- Inflammation of the medial portion of lower Eyelid (at medial canthus)
- Affects the region of the lacrimal sac
- Localized pain, tenderness, swelling and redness
- Purulent discharge from the lacrimal puncta
- Drainage increases with pressure over the lacrimal sac
- Chronic
- Pressure on puncta expresses fluid
- Conjunctivitis
- Blepharitis
- Exudate culture and Gram Stain (identifies MRSA)
- General
- Urgent ophthalmology referral (Incision and Drainage may be needed)
- Antibiotics in children
- Mild to moderate cases
- Amoxicillin-clavulanate (Augmentin)
- Severe cases
- Antibiotics in adults
- Mild to moderate
- Severe cases (2 Antibiotic regimens)
- Antibiotic 1 (choose one)
- Nafcillin or Oxacillin 2 grams IV every 4 hours
- Vancomycin 15-20 mg/kg IV every 8-12 hours (if MRSA suspected)
- Antibiotic 2 (choose one)
- Ceftriaxone 2 g IV every 24 hours
- Cefepime 2 g IV every 12 hours
- Levofloxacin 750 mg IV or oral every 24 hours (if Cephalosporin allergic)
- Antibiotic 1 (choose one)
- Trobe (2012) Physician's Guide to Eye Care, AAO, San Francisco, p. 62-3
- Gilbert (2012) Sanford Guide