Dacryocystitis has a bimodal distribution: neonates and individuals older than 40 years of age.
Most cases in neonates represent congenital abnormalities, whereas in adults it is usually the result of an acquired abnormality, including:
- inflammation / infection
- rhinitis / sinusitis
- paranasal sinus mucocele
- nasal septal abscess
- enlarged adenoids
- anatomic variation
- enlarged turbinates
- nasal septal deviation
- sinonasal carcinoma
- nasolacrimal duct carcinoma
- iatrogenic / trauma
- foreign bodies
Dacrocystitis is typically characterized by epiphora, erythema, and edema in the region of the medial epicanthus and lacrimal puncta as the result of an infection of the nasolacrimal sac. There is often mucopurulent discharge from the puncta and associated conjunctivitis.
Obstruction or stricture of the nasolacrimal drainage is generally an underlying factor, which may be acquired or congenital (see above).
The microbiology of dacryocystitis mimics normal conjunctival flora in most instances.
In chronic dacryocystitis, there can be superinfection with fungal species.
The typical imaging finding is a well circumscribed round lesion that is centered at the lacrimal fossa and that demonstrates peripheral enhancement.
Treatment and prognosis
Treatment of acute dacryocystitis typically involves treatment with antibiotics in the acute phase, which may or may not be followed by an external dacryocystorhinostomy or other interventional procedure.
Chronic dacryocystitis typically requires surgery or an interventional procedure.
- abscess formation
- fistula formation
- orbital cellulitis
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- 2. Lebedis CA, Sakai O. Nontraumatic orbital conditions: diagnosis with CT and MR imaging in the emergent setting. Radiographics. 2008;28 (6): 1741-53. Radiographics (full text) - doi:10.1148/rg.286085515 - Pubmed citation