Acute Dacryocystitis
Ophthalmology: Ocular Emergency (Lacrimal System)
1. Pathophysiology
Acute dacryocystitis is an acute, suppurative infection of the lacrimal sac, typically occurring due to complete nasolacrimal duct obstruction (NLDO). It is a rapid escalation from chronic stasis, often requiring emergent intervention.
2. Clinical Manifestations
| Symptom/Sign | Clinical Description |
|---|---|
| Pain & Tenderness | Severe, localized pain over the lacrimal sac (medial canthal region). |
| Inflammation | Marked erythema, edema, and warmth of the overlying skin; may mimic preseptal cellulitis. |
| Purulence | Frank purulent discharge from the punctum upon pressure. |
3. Management & High-Yield Pearls
- Emergency Management: Requires systemic antibiotics (e.g., cephalosporins or amoxicillin-clavulanate) targeting common pathogens like Staphylococcus aureus and Streptococcus spp.
- Contraindication: Do NOT attempt lacrimal syringing or probing during the acute phase; this can worsen the infection and potentially spread it into the orbit.
- Drainage: If an abscess has formed, incision and drainage may be necessary. Definitive treatment (DCR) should only be performed once the acute infection has fully resolved.
- Educational Resource: For antibiotic selection protocols, surgical timing, and practice questions, visit mymedschool.org.