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At least 19 recordsLinked to original sources

PubMedDate not supplied

Spectrum of pediatric dacryocystitis: medical and surgical management of 54 cases.

BACKGROUND: Dacryocystitis in infants and older children is a serious complication of congenital or acquired nasolacrimal duct obstruction. To define the modes of presentation and treatment strategies of this disorder better, we reviewed the clinical courses of 54 children treated for dacryocystitis at St Louis Children's Hospital. METHODS: Clinical, neuroradiologic, and laboratory data were collated for all cases of dacryocystitis treated from 1990 to 1995. Average follow up of the children in this consecutive series was 1.75 years (range, 4 months to 5 years). RESULTS: Of the 54 patients, 36 (67%) had chronic low-grade dacryocystitis, which was treated with nasolacrimal duct probing on an outpatient basis. The remaining 18 patients (33%) had acute dacryocystitis, which was treated with a combined medical/surgical strategy. Medical treatment consisted of hospital admission for administration of intravenous antibiotics followed by inpatient surgery, which varied according to the age of the patient and the clinical history: 1) Acute dacryocystitis in neonates was treated surgically by nasolacrimal duct probing and nasal endoscopy for excision of intranasal duct cyst; 2) Acute dacryocystitis with periorbital cellulitis was treated surgically by nasolacrimal duct probing; 3) Acute dacryocystitis due to facial trauma was treated surgically by dacryocystorhinostomy and stent placement; and 4) Acute dacryocystitis complicated by orbital abscess was treated by inferior orbitotomy for orbital abscess drainage, simultaneous nasolacrimal duct probing, and stent placement. CONCLUSION: Dacryocystitis in the pediatric population may present in either chronic or acute forms. An effective and safe treatment for acute dacryocystitis is hospital admission, both for administering intravenous antibiotics and monitoring to rule out orbital cellulitis or abscess formation. Intravenous antibiotic therapy is followed within a day or two by surgery tailored to the clinical history. In the majority of both chronic and acute cases, nasolacrimal duct probing appears to be an effective treatment strategy.

Abscess↗

PubMedDate not supplied

Nasal endoscopy in congenital dacryocystitis.

PURPOSE: Controversy exists regarding the relationship between nasal pathology and congenital dacryocystitis. The recent advent of nasal endoscopes has greatly improved visualization of deep and hidden areas of nasal anatomy and has led to the elaboration of nasal anatomical variants and pathologies that were previously unknown. The current study aimed to evaluate for associations, if any, between anatomical abnormalities or variations in the lateral nasal wall and the presence and resolution of congenital dacryocystitis. PATIENTS AND METHODS: Phase I was a case-control study that compared the incidence of a predefined set of nasal endoscopic variations in infants with congenital dacryocystitis versus normal infants. Phase II was a cohort study that evaluated the impact of nasal endoscopic variations on the effectiveness of conservative treatment for congenital dacryocystitis. "Failure" to respond to conservative treatment measures was defined as the persistence of symptoms at the first birthday. RESULTS: Inferior turbinate hypertrophy and inferior meatal narrowing were significantly more frequent in the case group than in the control group. Conservative treatment measures resulted in 70 of 83 resolved cases on subsequent follow-up. The occurrence of inferior turbinate hypertrophy or inferior meatal narrowing at final examination was associated with non-resolution. The relative risk of non-resolution with inferior turbinate hypertrophy or inferior meatal narrowing was 7.7 (confidence interval, 2.32 to 25.72) and 12 (confidence interval, 3.7 to 39.2), respectively. CONCLUSION: Inferior turbinate hypertrophy and inferior meatal narrowing are more frequent in cases of congenital dacryocystitis. They are predictive of a poor outcome when congenital dacryocystitis is treated with conservative measures. This information should be considered when making clinical decisions for patients with congenital dacryocystitis.

Case-Control Studies↗

PubMed1997

Surgical treatment of dacryocystitis.

Dacryocystitis is a common infection of the lacrimal sac. In adults, dacryocystitis results from an obstruction (ie, dacryostenosis) of the nasolacrimal duct. Dacryocystitis can be either an acute or chronic infection, and both forms usually are unilateral in nature. The hallmark symptom of both forms of dacryocystitis is epiphora (ie, excessive tearing). An obstruction of the lacrimal duct also can cause dacryocystitis. This article discusses the surgical treatment of dacryocystitis and provides a case study that illustrates perioperative nursing care of a patient who required surgical treatment of this lacrimal duct disorder.

Adult↗

PubMedDate not supplied

Dacryocystorhinostomy for dacryocystitis caused by methicillin- resistant Staphylococcus aureus: report of four cases.

BACKGROUND: To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA). CASES: Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics. OBSERVATION: Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively. CONCLUSION: Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.

Aged↗

PubMed2005

Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostomy in Nepal.

PURPOSE: To study the epidemiology of chronic dacryocystitis and the success rate of external dacryocystorhinostomy (DCR) in Nepal. PATIENTS AND METHODS: This is a retrospective descriptive and interventional case series. A total of 662 records of patients with chronic dacryocystitis due to nasolacrimal duct obstruction, who were treated by means of external DCR without bicanalicular silastic tube intubation, were studied. STATISTICS: Mean for age with standard deviation and confidence intervals were calculated. The significance of the difference in means was calculated using the unpaired t-test. RESULTS: Of 662 patients, 67.6% were female. The mean age of the patients was 27.4 +/- 13.7 years (SE = 0.53, 95% CI = 26.34-28.46). Chronic dacryocystitis due to nasolacrimal duct obstruction was found in 86 patients (13.0%) from the high hills (mean age = 35.3 +/- 11.4 years, 95% CI = 32.85-37.75), but most patients (576, 87.0%) were from the subtropical lowlands with a monsoon climate (mean age = 26.9 +/- 13.3 years, 95% CI = 25.8-28.0; p = < 0.01). An overall success rate of 88.6% (89.8% for high-hill patients and 87.4% for those from the lowlands) was obtained after DCR. CONCLUSION: Chronic dacryocystitis is more common in the subtropical plains of Nepal with a monsoon climate than in the high hills. It is predominantly found in pre-menopausal females. External DCR without bicanalicular silastic tube intubation is an effective method for treating chronic dacryocystitis due to NLDO in these patients.

Adolescent↗

PubMed1993

Acute dacryocystitis secondary to exudative rhinitis.

This report describes the unusual occurrence of acute dacryocystitis secondary to exudative rhinitis. An 18-year-old man with no prior history of tearing or dacryocystitis presented with acute left dacryocystitis. Nasal mucosal edema, lymphoid hyperplasia, and exudate obstructed the ostium of his left nasolacrimal duct. The patient improved rapidly with systemic antibiotic and nasal decongestant drugs. Both the nasolacrimal duct obstruction and dacryocystitis resolved completely within 2 weeks. One year later, serology suggested Epstein-Barr virus as the cause of the rhinitis. Acute intranasal inflammation may obstruct the nasolacrimal duct with potential secondary dacryocystitis. This type of nasolacrimal duct obstruction resolves without sequelae when the rhinitis improves.

Acute Disease↗

PubMed2001

Endonasal dacryocystorhinostomy in the primary treatment of acute dacryocystitis with abscess formation.

PURPOSE: To determine whether endonasal dacryocystorhinostomy may constitute effective primary treatment of acute dacryocystitis with lacrimal sac abscess formation. METHODS: This was a retrospective review of a series of 24 patients with acute dacryocystitis and lacrimal sac abscess who underwent endonasal dacryocystorhinostomy as a primary procedure. Outcome measures included resolution of signs and symptoms of acute dacryocystitis as well as intranasal ostium patency as assessed by lacrimal irrigation. RESULTS: Pain was relieved in all patients within 3 days of surgery, and swelling resolved in all patients by 9 days after surgery. Ostium patency, as defined by the absence of epiphora, and free lacrimal irrigation was achieved in 20 (83%) of 24 patients, with follow-up of 27 to 59 months (mean, 40 months). Recurrent epiphora developed in four patients; recurrent dacryocystitis developed in none. CONCLUSIONS: Endonasal dacryocystorhinostomy may be a useful option in the treatment of acute dacryocystitis with abscess formation.

Abscess↗

PubMed2004

The treatment of acute dacryocystitis using laser assisted endonasal dacryocystorhinostomy.

AIMS: To determine whether acute dacryocystitis complicated by abscess formation can be successfully treated using laser assisted endonasal dacryocystorhinostomy. METHODS: A protocol was adopted for the management of acute dacryocystitis presenting to an ophthalmology department. All patients were assessed jointly by an ophthalmologist and otolaryngologist for their suitability for primary internal drainage via a nasal endoscopic approach. All suitable patients during the study period August 1999 to November 2000 were managed by intravenous antibiotics and holmium:YAG laser dacryocystorhinostomy. RESULTS: Nine patients were studied (mean age 72 years (range 38-82 years), three men, six women). A history of chronic epiphora was found in 78% of patients, and recurrent nasolacrimal infections in the same 78%. Resolution of symptoms and signs of acute dacryocystitis occurred in all nine patients. No recurrence of acute dacryocystitis occurred during the median follow up period of 11 months (range 6-31 months). Ostium patency defined as the absence of epiphora and the observation of irrigated lacrimal fluorescein at the ostium was achieved in 67% of patients. Epiphora recurred in 33% of cases. CONCLUSION: Laser assisted endonasal dacryocystorhinostomy is an effective primary treatment in cases of acute dacryocystitis complicated by abscess formation. In addition, pre-existing symptoms of epiphora and recurrent nasolacrimal infections are relieved in the majority of patients.

Abscess↗

PubMedDate not supplied

Treatment of acute dacryocystitis in neonates.

Twenty-five newborns with acute dacryocystitis underwent probing of the nasolacrimal duct. All had a resolution of the acute dacryocystitis. Only one continued to have epiphora and had to undergo a subsequent probing with silicone intubation at 9 months of age. All were probed without anesthesia, being mummified and held by nurses while the author performed the probing. Only five were treated with parenteral and topical antibiotics for a week prior to probing while 20 were probed without any prior antibiotic therapy. Additionally, five of six mucoceles of the lacrimal sac which did not resolve in the 1st 2 weeks of life with massage were successfully probed without anesthesia. Four of the five mucoceles had developed an acute dacryocystitis on conservative management. Probing of the nasolacrimal duct in the newborn period is a safe and successful approach for acute dacryocystitis. It is a highly successful procedure for the treatment of acute dacryocystitis with a very low morbidity rate.

Acute Disease↗

PubMedDate not supplied

Fungal flora in congenital dacryocystitis.

In this study, 86 eyes in 66 cases (20 bilateral) of congenital dacryocystitis were analysed for fungal growth. Fungi alone were isolated in 12 eyes (13.95%) and in 14 eyes (16.28%) together with bacteria--a total of 26 positive for fungus in 86 eyes (30.23%). These 26 eyes yielded on fungal culture a total of 28 isolates (in 2 eyes, another fungus was isolated on repeat culture). 11 types of fungi were cultured--C. albicans and A. niger accounted for 5 each out of 28. To the best of our knowledge this is the first report in the literature of fungal flora analysed in congenital dacryocystitis--not surprisingly, more than 30% of eyes were positive for fungus. Systemic studies of fungal flora in dacryocystitis are very few, and hardly any literature on this subject exists in congenital dacryocystitis. This study is an attempt to determine the frequency and clinical significance of fungi isolated from cases of congenital dacryocystitis.

Dacryocystitis↗

PubMed1993

Dacryocystitis associated with malignant lymphoma of the lacrimal sac.

BACKGROUND: Tumors of the lacrimal sac are unusual, and lymphomas of the lacrimal sac are quite rare. Four patients with a history of well-differentiated, small cell lymphoma or chronic lymphocytic leukemia presented with either acute or chronic dacryocystitis and epiphora due to lymphomatous infiltration of the lacrimal sac. METHODS: All four patients underwent dacryocystorhinostomy with lacrimal sac biopsy. All tissues underwent complete histopathologic evaluation including immunohistochemical studies for cell surface markers and, in addition, were compared with previous biopsies performed for the initial diagnosis of lymphoma. FINDINGS: All biopsies demonstrated small cell well-differentiated lymphoma on histologic and immunofluorescent examination. No patient demonstrated orbital involvement on computed tomography. One patient had previously diagnosed chronic lymphocytic leukemia and one patient demonstrated diffuse lymph node involvement on postoperative systemic evaluation. All four patients underwent additional chemotherapy. No recurrence of dacryocystitis or epiphora occurred. CONCLUSION: Four patients presented with dacryocystitis secondary to lacrimal sac lymphoma. Lymphomatous lacrimal sac infiltration is an unusual cause of dacryocystitis. Biopsy of the lacrimal sac plays a diagnostically important role in dacryocystorhinostomy even in the absence of obvious tumorous involvement of the lacrimal sac mucosa.

Acute Disease↗

PubMed1993

Chronic dacryocystitis caused by Mycobacterium fortuitum.

PURPOSE: To characterize the clinical presentation of Mycobacterium fortuitum dacryocystitis, an unusual microbial cause of this disease. METHODS: The authors present a detailed description of a case of M. fortuitum chronic dacryocystitis and a review of the literature. FINDINGS: Although M. fortuitum is a well-recognized cause of chronic keratitis and corneal ulcer, it has only been reported once previously as a cause of dacryocystitis. Multiple factors that alter the ocular environment of the host may predispose to infection with this organism. The diagnosis requires isolation of the organism in the appropriate clinical setting. The authors' case represents the first patient successfully treated with dacryocystectomy. CONCLUSION: M. fortuitum is a rare cause of chronic dacryocystitis that may respond favorably to surgical therapy alone.

Chronic Disease↗

PubMed2005

Bacteriology of chronic dacryocystitis in a tertiary eye care center.

PURPOSE: To determine the current bacteriology of adult chronic dacryocystitis in a tertiary eye care center and compare it with previously reported studies. METHODS: Clinical and microbiological records of patients with diagnosis of chronic dacryocystitis between January 1999 and March 2002 were reviewed for age, sex, lacrimal sac side involved, and culture results. Patients younger than 16 years of age and patients who were receiving any systemic or topical antibiotics were excluded from the study. RESULTS: One hundred eighty-eight adult patients with an average age of 50.5 years (range, 16 to 91 years), who had a diagnosis of chronic dacryocystitis, were identified. The study was predominated by female subjects (65.4%). Of the cultures from the nasolacrimal sac, 183 (97.3%) were positive for bacteria, with an average of 2.3 (1 to 6) microorganisms. More than 2 microorganisms were present in 66.1% of the cultures, whereas a single microorganism was recovered from 33.9% of the cultures. The majority of microorganisms in our study were Gram-positive bacteria, representing 53.7% of the overall microorganisms cultured with a predominance of Staphylococcus species. Gram-negative bacteria were recovered from 26.0% of the specimens with predominance of Haemophilus influenzae. Anaerobic microorganisms were present in 19.1% of the samples. The most frequently isolated anaerobic microorganisms were Propionibacterium acne and Peptostreptococcus species. CONCLUSIONS: Several bacterial species may be involved in the pathogenesis of chronic dacryocystitis in adults, and the majority of patients harbor multiple microorganisms in their nasolacrimal sacs. The high rate of microorganism-positive lacrimal sac cultures suggests that adult patients should be treated for their infection before any intraocular surgery because of the potential risk of infection.

Adolescent↗

PubMedDate not supplied

Neonatal dacryocystitis associated with nasolacrimal duct cysts.

Neonatal dacryocystitis is a rare complication of congenital nasolacrimal duct (NLD) obstruction. Recent reports suggest that the association of neonatal dacryocystitis and NLD cysts may be more common than previously believed. The purpose of this study is to describe the nasal endoscopic findings and treatment of three patients with this disorder. In this prospective study, three consecutive patients who presented at 2 weeks of age or less with dacryocystitis were treated with NLD probing and rigid nasal endoscopy. All patients were found to have congenital NLD cysts at the time of NLD probing. The cysts were marsupialized under endoscopic visualization. The treatment was successful in all patients. Dacryocystitis in the early newborn period is commonly associated with NLD cysts. Nasal endoscopic marsupialization of the cysts is an effective adjunct to treatment of these patients.

Cysts↗

PubMed1995

[Tuberculous dacryocystitis].

BACKGROUND: Acute infection and inflammation of the nasolacrimal sac may complicate congenital obstruction of the nasolacrimal duct. Acute dacryocystitis is uncommon later and tuberculosis is exceptionally responsible for it. CASE REPORT: A 4 1/2 year-old boy was admitted because he suffered from acute left dacryocystitis with fever and cervical adenitis. Involvement of both lacrymal gland and lymph node persisted despite antibiotic and corticosteroid therapy. Needle biopsy of the lymph node showed presence of Mycobacterium tuberculosis and excision revealed caseating granulomas. The tuberculin skin test was positive while pulmonary tuberculosis was discovered in the patient's father. The patient was successfully given izoniazid, rifampin for 9 months and pyrazinamide for 2. Drainage of the sac area was necessary after 1 month of treatment followed by dacryocystorhinostomy. CONCLUSION: This rare case of tuberculous dacryocystitis permits to delineate the difficulties of ophthalmologic therapy.

Acute Disease↗

PubMedDate not supplied

Lectin cytochemistry of the lacrimal sac epithelium in experimental dacryocystitis.

PURPOSE: To study the glycoconjugates in the lacrimal sac epithelium of Japanese white rabbits with experimentally induced chronic dacryocystitis. METHODS: Chronic dacryocystitis was induced by a subcutaneous injection of albumin followed by an injection of Staphylococcus aureus into the lacrimal sac. The histological appearance of the lacrimal sac was studied using the alcian blue-periodic acid-Schiff sequence. In addition, the specific binding to the lacrimal sac epithelium of Ulex europaeus agglutinin 1, Ricinus communis agglutinin 1, peanut agglutinin, and soybean agglutinin was also studied. RESULTS: Staining with alcian blue-periodic acid-Schiff sequence showed hyperplasia of the goblet cells in the inflamed lacrimal sac epithelium. Lectin cytochemistry revealed specific binding of Ulex europaeus agglutinin 1, Ricinus communis agglutinin 1, peanut agglutinin, and soybean agglutinin to the lacrimal sac epithelium. CONCLUSIONS: These results indicated that the composition of glycoconjugates in the lacrimal sac epithelium is markedly changed in dacryocystitis. There seems to be a fundamental abnormality in glycoconjugate synthesis in the chronically inflamed lacrimal sac epithelium.

Animals↗

PubMed2005

Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis.

OBJECTIVE: To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. MATERIALS AND METHODS: We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. RESULTS: The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria; 16 isolates (39%) were Gram-positive and 25 (61%) were Gram-negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, E. coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in two cases (5%), and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciproxin in 86%, and cefuroxime in 50% of cases, with sensitivity of less than 30% to cephalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidine, 86% were sensitive to ciprofloxacin, with only 20% being sensitive to ampicillin and 14% to cephalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidine. CONCLUSION: This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer highly resistant Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.

Adolescent↗

PubMed2005

Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis.

PURPOSE: To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. MATERIALS AND METHODS: We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. RESULTS: The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria. Sixteen isolates (39%) were Gram positive and 25 (61%) were Gram negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, Escherichia coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in 2 cases (5%) and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciprofloxacin in 86% and cefuroxime in 50%, with a sensitivity of less than 30% to cefalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidime, 86% were sensitive to ciprofloxacin, while only 20% were sensitive to ampicillin and 14% to cefalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidime. CONCLUSION: This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer, highly resistant, Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.

Adolescent↗