Dacryoadenitis, Dacryocystitis, and Canaliculitis

Key Concepts

• Dacryoadenitis may be infectious (e.g., Staphylococcus aureus , Streptococcus pneumoniae ) or noninfectious (nonspecific orbital inflammation) in etiology.

• Those with infectious dacryoadenitis usually feel unwell and are febrile in contrast to those in the noninfectious group who generally feel well but have pain as their major symptom.

• Dacryocystitis is a result of an obstruction within the nasolacrimal sac; it may occur at any age and can be acute (common) or chronic (uncommon).

• Infants are obligate nasal breathers, and airway obstruction with respiratory distress from an obstructed nasolacrimal duct (dacryocystocele, amniotocele, dacryocystitis) requires urgent treatment.

• Individuals with a dacryolith are commonly females in their 30s–40s with intermittent bouts (1–2 weeks) of a pressure feeling in the medial canthal region followed by tearing, discharge, possibly a concomitant dacryocystitis) and a lump in the nasolacrimal sac area.

• Acute dacryocystic retention refers to the acute obstruction of the nasolacrimal duct with a dacryolith, mucous plug, blood clot, or environmental foreign body. Patients present with a short history of tearing and sudden severe pain out of proportion to the clinical findings; some describe it as worse than childbirth.

• Primary acquired nasolacrimal duct obstruction refers to the gradual narrowing of the nasolacrimal duct with age resulting in the backup of tear flow, tearing, and with time complete nasolacrimal duct obstruction and eventual dacryocystitis.

• Infections involving the lacrimal canaliculus are often overlooked as a cause for chronic recurrent unilateral conjunctivitis.

• The typical presentation of a canaliculitis is a unilateral conjunctival inflammation with discharge despite numerous antibiotics and assessments by other physicians.

• Treatment of canaliculitis is primarily surgical and involves opening the canaliculus with a punctoplasty and milking out the debris with cotton-tipped applicators. Curetting the canaliculus should be abandoned as it may damage the canalicular walls and produce scarring in this delicate structure.