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PubMed2005

Dacryocystitis caused by community-onset methicillin-resistant Staphylococcus aureus.

PURPOSE: To describe the occurrence of community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections of the lacrimal system and their treatment. METHODS: This cases series consisted of data obtained from seven clinical cases of acute or subacute MRSA dacryocystitis, with or without concurrent conjunctivitis, occurring in nonhospitalized individuals presenting between December 2001 and July 2003. Clinical presentations, microbial culture results, treatment modalities, and outcomes were retrospectively reviewed. RESULTS: Three patients were successfully treated with antibiotics and lacrimal surgery with no recurrence of symptoms after surgery for 6 months or longer. Four patients had temporary relief of symptoms with antibiotic therapy, but surgery was not performed for non-ophthalmologic reasons, and recurrence occurred. CONCLUSIONS: The treatment of MRSA dacryocystitis can be challenging. Microbiologic cultures should be performed in all patients with dacryocystitis that is unresponsive to conventional first-line antibiotic treatment and in patients at risk for acquisition of MRSA. Appropriate antibiotic therapy in combination with dacryocystorhinostomy appears to be the optimal treatment.

Acute Disease↗
PubMed2005

Rhabdomyosarcoma masquerading as acute dacryocystitis.

An 11-year-old boy presented with right medial canthal swelling. He was initially diagnosed with dacryocystitis and treated with oral antibiotics, followed by incision and drainage of a presumed lacrimal sac abscess. Rapid recurrence of the swelling led to further clinical evaluation, including a maxillofacial CT, which revealed an extensive nasal and orbital mass that was consistent with embryonal rhabdomyosarcoma on histopathologic analysis. This represents an unusual case of rhabdomyosarcoma manifesting as acute dacryocystitis. Rhabdomyosarcoma should be considered in the differential diagnosis for acquired nasolacrimal obstruction and dacryocystitis in the pediatric population.

Biopsy↗
PubMed2005

Microbiological analysis of chronic dacryocystitis.

AIMS: To investigate the microbiology of specimens from patients with chronic dacryocystitis. METHODS: A total of 100 samples were obtained from the contents of the lacrimal duct in 91 consecutive patients with chronic dacryocystitis, including nine bilateral cases. These samples were cultured for aerobic and anaerobic bacteria and fungi with a routine microbiological technique. Positive cultured isolates were identified. RESULTS: A total of 180 strains were isolated from the 85 bacterial samples, including 150 strains of aerobic bacteria and 30 strains of anaerobic bacteria. Fungi were found in eight samples and actinomyces in three samples. The bacterial species that were most frequently found were Staphylococcus species, representing 34.5% of all strains, followed by Corynebacterium diphtheroides (15.5%). The sensitivity tests revealed that levo-ofloxacin and amikacin were the most effective antibiotics. CONCLUSIONS: Gram positive cocci was the predominant pathogen of chronic dacryocystitis. Levo-ofloxacin and amikacin had the best effect in vitro.

Adolescent↗
PubMed2005

Bilateral nasolabial cysts associated with recurrent dacryocystitis.

OBJECTIVE: Nasolabial cysts are rare, nonodontogenic, soft-tissue, developmental cysts occurring inferior to the nasal alar region. They are thought to arise from remnants of the nasolacrimal ducts and they are frequently asymptomatic. We report a rare case of bilateral nasolabial cysts accompanied by bilateral chronic dacryocystitis. CASE REPORT: A 48-year-old woman suffering from bilateral chronic dacryocystitis was referred to our department for endonasal dacryocystorhinostomy. She had undergone external dacryocystorhinostomy on the left side a few years earlier. Physical examination and computed tomography scan revealed nasolabial cysts bilaterally inferior to the nasal alar region. The cysts were removed via a sublabial approach and endoscopic dacryocystorhinostomy was performed on the right side. Ten months after surgery, the patient was asymptomatic. CONCLUSION: There may be a correlation, due to embryological reasons, between the presence of nasolabial cysts and the presence of chronic dacryocystitis. Both can be corrected surgically, under the same anaesthesia, without visible scar formation.

Chronic Disease↗
PubMed2002

[Mycotic dacryocystitis related to naso-lacrimal stent. Case report].

CASE REPORT: A nasolacrimal stent was placed in a diabetic woman with a ten-year history of epiphora. Three months later the non-functional stent was removed and taken for histological study. A presumed diagnosis of fungical dacryocystitis was then established. An external dacryocystorhinostomy was performed and the obtained cultures confirmed Candida albicans as the infective agent. DISCUSSION: Only 1.2% of all dacryocystitis are due to fungal agents. This possibility must be considered when evaluating a routine chronic dacryocystitis. Cultures should be obtained when removing a nasolacrimal stent in order to rule out different causes of nasolacrymal obstruction.

Candidiasis↗
PubMed1999

[Treatment for chronic dacryocystitis by probing through naso-lacrimal duct under endoscopy].

OBJECTIVE: To determine the possibility of curing chronic dacryocystitis by probing through naso-lacrimal duct under endoscopy. METHOD: 30 adult eyes with chronic dacryocystitis were divided into two groups: 20 treated under endoscopy as endoscopy group and 10 under rhinoscope as control. RESULT: In endoscopy group, treatment in all 20 eyes successed at the first time, but in control group only in 8 of the 10 eyes successed at the first time and the other 2 needed second surgery. CONCLUSION: Treatment for chronic dacryocystitis by probing through naso-lacrimal duct under endoscopy is better.

Chronic Disease↗
PubMed2005

[Domestic 1.44 mcm Nd:YAG laser in combined treatment of dacryocystitis complicated by abscess formation].

We have treated 12 patients with acute dacryocystitis complicated by abscess formation. All the patients were examined by an ophthalmologist and otolaryngologist. The patients received intravenous antibiotics followed by Nd:YAG laser dacryocystorhinostomy via transcanalicular approach under the endonasal endoscopic control. The treatment resulted in resolution of symptoms and signs of acute dacryocystitis complicated by abscess formation in all the patients. No recurrence of acute dacryocystitis occurred during the median follow-up period of 11 months. Ostium patency defined as the absence of epiphora and observation of irrigated lacrimal fluorescein at the ostium was achieved in 9 patients. Epiphora recurred in 3 cases. Use of Nd:YAG laser reduces the duration of the operation and provides maximal functional and cosmetic results.

Abscess↗
PubMedDate not supplied

[Results of endonasal intubation of the nasolacrimal duct in children with congenital dacryocystitis].

Results of endonasal catheterization of the naso-lacrimal canal of 74 children with congenital dacryocystitis (bilateral problem in 10 of them) are presented. Prior to this manipulation, the patients were exposed to contrast X-ray study of the lacrimal sac for diagnostic purposes. Retrograde catheterization as a method for treating congenital dacryocystitis was very good in 97.3% children of up to 2 years old, 50% children of up to 3 years old, and 33.3% children between 3-4 years old. The patency of the naso-lacrimal canal also recovered in an 8-year-old child. All this gives evidence that, irrespective of children's age, retrograde catheterization should be applied to treat congenital dacryocystitis. After the patency of the naso-lacrimal canal was restored, the external fistula of the lacrimal sac was cauterized with 7% solution of trichloroacetic acid.

Adolescent↗
PubMed1989

[Problems of the diagnosis and differential treatment procedures in congenital dacryocystitis].

The paper analyses effectiveness of treatment for dacryocystitis in 223 children, aged from 1 months up to 15 years. In 35 children the process was bilateral. In 232 cases dacryocystitis was congenital, in 26--acquired. Complex examination of lacrimal and upper respiratory tracts has revealed pathology in 53% of cases. In these cases preliminary sanation of upper respiratory tracts was made. A scheme of a staged treatment for congenital dacryocystitis is proposed, and results after treatment by retrograde catheterization in 161 children aged to 1.5 year and by endonasal dacryorhinostomy in 62 children above 2.5 years of life are analysed.

Adolescent↗
PubMed1987

Dacryocystitis. Late complication of orbital floor fracture repair with implant.

Fifteen years after orbital floor fracture repair with a silicone implant, dacryocystitis unresponsive to medical management developed in a 66-year-old woman. On examination, the edge of the implant was palpable at the most medial aspect of the inferior orbital rim in the anatomic area of the nasolacrimal sac. Orbital computed tomography (CT) scan and intraoperative probing and irrigation of the nasolacrimal system confirmed that the implant obstructed the nasolacrimal sac at the floor of the orbit. Removal of the implant combined with dacryocystorhinostomy has led to resolution of the dacryocystitis. To the authors' knowledge, dacryocystitis as a late complication of orbital floor fracture repair with an orbital floor implant has not been previously reported. This case demonstrates that orbital floor implants should not be placed too anteriorly or too medially in the anatomic region of the lacrimal sac and that they should be fixed to prevent implant migration.

Aged↗
PubMed1996

Role of dacryocystectomy in the management of failed dacryocystorhinostomy associated with chronic dacryocystitis.

Three patients had recurrent chronic dacryocystitis but no epiphora associated with failed dacryocystorhinostomies. Dacryocystectomy was performed on all three patients. These patients were cured of dacryocystitis following dacryocystectomy and none had epiphora postoperatively. There may be a group of patients with dry eyes and chronic dacryocystitis in whom dacryocystorhinostomy is likely to fail. Such patients may respond favorably to dacryocystectomy.

Aged↗
PubMed2006

Community-acquired methicillin-resistant Staphylococcus aureus in association with chronic dacryocystitis secondary to congenital nasolacrimal duct obstruction.

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important pathogen responsible for serious ocular and systemic disease. MRSA has been reported to occur in dacryocystitis in the adult population. This is the first case report of community-acquired MRSA in the pediatric population in association with chronic dacryocystitis secondary to congenital nasolacrimal duct obstruction in an infant.

Chronic Disease↗
PubMed2003

Facial necrotizing fasciitis following acute dacryocystitis.

PURPOSE: To report a case of progressive necrotizing fasciitis of the face following acute dacryocystitis. DESIGN: Interventional case report. METHODS: A 60-year-old woman presented with left acute dacryocystitis with abscess formation that had ruptured; a small wound remained. Erythematous swelling of the left eyelid and face developed 3 days later. Clinical progression and computed tomographic findings led to the diagnosis of necrotizing fasciitis with abscess formation. Early intravenous antibiotics and repeated surgical debridements were performed. RESULTS: Soft tissue necrosis was found the fascial planes extending deep to the maxilla bone and periorbital fat. The patient was successfully treated without ocular, orbital, or facial complications. CONCLUSIONS: Necrotizing fasciitis of the eyelid and face progresses rapidly. Early diagnosis, prompt intravenous antibiotic administration, and aggressive surgical debridement will prevent the associated morbidity and mortality.

Abscess↗
PubMed1999

Acute dacryocystitis as a presenting sign of pediatric leukemia.

PURPOSE: To report acute dacryocystitis with preseptal cellulitis as the presenting sign of leukemia in a child. METHODS: Case report and literature review. RESULTS: During the initial evaluation of a 17-month-old child with epiphora, left lower eyelid swelling, and a tender left medial canthal mass, a complete blood cell count demonstrated pancytopenia. Bone marrow biopsy disclosed replacement of normal cellular architecture with a dense infiltrate of leukocyte blast forms. DNA analysis disclosed a translocation between chromosome 10 and 11, consistent with the diagnosis of nonlymphocytic leukemia. Although the adjacent lower eyelid cellulitis responded to intravenous antibiotics, lacrimal sac distention decreased only after chemotherapy was initiated. CONCLUSIONS: Dacryocystitis with preseptal cellulitis can be a presenting sign of leukemia. This blood malignancy should be considered in patients whose leukocyte counts do not correlate with their clinical presentation.

Acute Disease↗
PubMed1998

Aerobic and anaerobic microbiology of dacryocystitis.

PURPOSE: To investigate the aerobic and anaerobic microbiology of dacryocystitis. METHOD: Retrospective review of the 62 clinical and microbiologic records collected between 1980 and 1990. RESULTS: Aerobic or facultative bacteria were recovered in 32 cases (52%), anaerobic bacteria only in 20 cases (32%), mixed aerobic and anaerobic bacteria in seven cases (11%), and fungi in three cases (5%). A total of 94 organisms (1.5 per specimen), which included 56 aerobic or facultative anaerobic organisms, 35 anaerobic organisms, and three fungi, were recovered. The predominant aerobic and facultative bacteria were Staphylococcus aureus (15 isolates), Staphylococcus epidermidis (13 isolates), and Pseudomonas species (seven isolates). The most frequently recovered anaerobes were Peptostreptococcus species (13 isolates), Propionibacterium species (12 isolates), Prevotella species (four isolates), and Fusobacterium species (three isolates). The predominant fungus was Candida albicans (two isolates). Polymicrobial infection was present in 28 cases (45%). CONCLUSION: These data highlight the potential importance of anaerobic bacteria in dacryocystitis.

Adolescent↗
PubMed1992

Atypical presentation of fungal dacryocystitis. A report of two cases.

BACKGROUND: Candida albicans has only rarely been implicated in nasolacrimal duct obstruction. Its association with dacryoliths is well known, but it is unclear whether it is an etiologic factor or is present as a result of the obstruction. FINDINGS: The authors report 2 cases of fungal dacryocystitis that were not associated with dacryolith formation and where Candida species appear to be the primary etiologic agent. CONCLUSION: The possibility of a fungal infection should be considered in the evaluation of "routine" chronic dacryocystitis, particularly in the presence of corneal ulceration or postoperative endophthalmitis, as prompt initiation of appropriate therapy may be crucial.

Aged↗
PubMed2002

Acute dacryocystitis presenting as an orbital abscess.

Acute dacryocystitis usually presents as a preseptal infection, but can uncommonly be associated with orbital cellulitis. Orbital abscess formation is, however, very rare. The case is presented of a 60-year-old woman with an extraconal abscess secondary to acute dacryocystitis. The clinical, radiological and intraoperative findings are discussed.

Abscess↗
PubMed1997

[Sarcoidosis of the paranasal sinuses as the etiology of therapy refractory dacryocystitis].

BACKGROUND: Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating granulomatous inflammation of various organs. The clinical findings when nasal mucosa is involved include nasal crusting, epistaxis, pain and/or anosmia, nasal polyps, or submucosal nodularity. CASE REPORT: We describe a case of sarcoidosis of the paranasal sinuses. In a 33-year-old man, the first symptom was therapy resistant putrid dacryocystitis. Further there had been symptoms of chronic sinusitis. A CT scan revealed swelling of the mucosa in the anterior ethmoid, frontal recess, and maxillary sinus. As the disease obviously affected the region of the nasolacrimal duct with consecutive stenosis of this canal, we opted for endoscopic sinus surgery. A few days after this endoscopic procedure, the dacryocystitis had healed. RESULTS: The histopathological examination showed the typical picture of sarcoidosis that had its primary manifestation in the paranasal sinuses. According to these findings further explanation of the patient was necessary. The diagnosis of sarcoidosis was confirmed by lavage and biopsy material of bronchoscopically suspect lung areas. Consequently, the patient underwent a long-term corticoid therapy and today, 10 months after the surgical intervention, the patient is free of symptoms. Follow-up endoscopy of the paranasal sinuses showed no further pathological findings. CONCLUSION: Our case demonstrates that the first manifestation of sarcoidosis can be in the paranasal sinuses.

Adult↗