• 601 Providence Park Drive, Suite O, Mobile, Alabama,36695
    251-650-5437
  • 27961 U.S. 98, Thomas Medical Center, Daphne, Alabama,36526
    251-928-1941
  • 1720 Medical Park Dr, Suite 330a, Biloxi, Mississippi,39532-2131
    228-396-5185

Lacrimal System Infections

Dacryoadenitis

  • Symptoms include pain, tenderness and swelling of {the} lateral aspect of {the} eyelid
  • May occur with systemic diseases such as Sjogren's, sarcoidosis, syphilis, TB, lymphoma, and benign lymphoid hyperplasia
  • May occur in patients with mums, EBV, zoster

Canaliculitis

  • Canaliculitis is a clinical condition that is characterized by infection of {the} canaliculi in {the} eye. It commonly affects individuals over {the} age of 50 years. It is caused due to obstruction within {the} canaliculus, {the} presence of a foreign body or {the} presence of diverticulum which harbours bacteria within it.

Pathophysiology of canaliculitis

As has been mentioned above, canaliculitis occurs due to infection of {the} canaliculi. This infection is often brought on by bacteria though there might be alternative aetiology such as fungi and viruses as well. The most common cause of canaliculitis is Actinomyces Israelii. However, {the} other causes can include aspergillus, Canada albicans and even herpes simplex and herpes zoster virus.

Infection by these organisms results in {the} formation of tiny stones that are rich in sulphur. These stones form little pockets that unfortunately are not affected by {the} antimicrobial properties of tears.

History and examination

Canaliculitis

Patients often complain of a long-standing history of one eye being red and inflamed. The inner aspect of {the} eye constantly displays a thick discharge which can be clear or rather discoloured.

On examination, {the} lacrimal punctum is swollen and inflamed. The swelling is due to accumulation of fluid and is called oedema. The area is tender to touch. When gently compressed, {the} cloudy, purulent discharge is expressed through {the} punctum.

  • Diagnosis

Diagnosis is through clinical history and examination in most cases. If a probe is passed through {the} lacrimal punctum, a grating sensation is experienced due to {the} presence of sulphur stones (concretions) within it.

Laboratory investigations are conducted on {the} discharge. Tests are conducted to ascertain {the} type of infection that is affecting {the} canaliculus. Staining might be performed with a different stains and microscopic assessment might reveal {the} presence of organisms such as Actinomyces or aspergillus.

Treatment

  • The treatment of canaliculitis is fairly straightforward and involves {the} application of warm compressions, massage of {the} local area and antibiotic creams and ointments applied locally. These treatments might or might not help {the} patient. In {the} event of this being {the} case, patients might require to undergo a surgical procedure to help clear {the} infection. This is usually offered when irrigation with a sterile solution and broad-spectrum antibiotics is ineffective. Procedures can include deployment of {the} canaliculus through a procedure called canaliculotomy.
  • The procedure is fairly straightforward and is performed by making a tiny incision on {the} conjunctival aspect of {the} canaliculus. The sulphur concretions are then removed and antibiotics are used to clear any residual infection.

Conclusion

  • Canaliculitis is a rare condition that affects individuals over {the} age of 50 years. It is characterised by bacterial or fungal infections within {the} canaliculi and {the} formation of concretions that are rich in sulphur. Treatments can include topical antibiotics and drainage, though in some cases surgical treatment might be required.
  • Symptoms include pain, swelling, tenderness of {the} INNER canthus of {the} eye
  • Etiology is usually actinomycetes

Dacryocystitis

  • Symptoms: acute onset, tearing (from nasolacrimal duct obstruction), redness, purulent discharge, tender swollen lacrimal sac
  • An infection within {the} "tear duct" causes a painful swelling in {the} inner corner of {the} eyelids.
  • If {the} tearing causes severe symptoms, surgery can be performed to create a new tear duct. This operation is called "dacryocystorhinostomy." (see below). Small silicone tubes my be placed in {the} tear system to keep {the} new tear duct open while healing occurs. Surgical elimination of {the} obstruction by creating a new tear duct is necessary to eliminate {the} tearing and infection that can result from such a blockage

Acute Dacryocystitis

Acute Dacryocystitis - Lacrimal duct infection

 

  • several etiologies, all cause nasolacrimal duct obstruction with obstruction of drainage from lacrimal sac to nose
    • chronic tear stasis causes 2o infxn
    • edema, erythema below medial canthal tendon w/lac sac distention
    • +/- pain
    • rule out ethmoidal sinusitis, don't probe
  • Treatment
    • warm compresses
    • oral/IV abx (Keflex, Augmentin), topical only limited value
    • Incision Drainage localized abscess
  • Complications
    • mucocele, chronic conjunctivitis, orbital cellulitis
    • most need DCR after acute infection subsides

Acute Dacryocystitis - Lacrimal duct infection

Chronic Dacryocystitis

  • distended lac sac with minimal inflammation suppurative discharge from punctum c/w nasolacrimal duct obstruction
  • probe/irrigate upper system only
  • dacryoliths from Actinomyces, Candida, topical meds, can cause lacrimal colic if impacted in NLD
  • Treatment usually needs DCR for resolution

 

 Lacrimal Fistula

Patient with chronic, recurrent dacryocystitis