Disorders of the Lower Lacrimal System 331 Dacryocystitis

Inflammation of the lacrimal sac is the most frequent disorder of the lower lacrimal system. It is usually the result of obstruction of the nasolacrimal duct and is unilateral in most cases.

3.3.1.1 Acute Dacryocystitis

Epidemiology: The disorder most frequently affects adults between the ages of 50 and 60.

Etiology: The cause is usually a stenosis within the lacrimal sac. The retention of tear fluid leads to infection from staphylococci, pneumococci, Pseudomonas, or other pathogens.

Symptoms: Clinical symptoms include highly inflamed, painful swelling in the vicinity of the lacrimal sac (Fig. 3.9) that may be accompanied by malaise, fever, and involvement of the regional lymph nodes. The pain may be referred as far as the forehead and teeth. An abscess in the lacrimal sac may form in advanced disorders; it can spontaneously rupture the skin and form a drain-ingfistula.

— Radiographic image of the lower lacrimal system. -

Fig. 3.8 Digital

system and can demonstrate a possible stenosis (arrow) without superimposed bony structures.

dacryocystography images the lower lacrimal substraction system and can demonstrate a possible stenosis (arrow) without superimposed bony structures.

dacryocystography images the lower lacrimal substraction

— Acute dacryocystitis.

— Acute dacryocystitis.

Fig. 3.9 Typical symptoms include highly inflamed, painful swelling in the vicinity of the lacrimal sac.

Acute inflammation that has spread to the surrounding tissue of the eyelids and cheek entails a risk of sepsis and cavernous sinus thrombosis, which is a life-threatening complication.

Diagnostic considerations: Radiographic contrast studies or digital sub-straction dacryocystography can visualize the obstruction for preoperative planning. These studies should be avoided during the acute phase of the disorder because of the risk of pathogen dissemination.

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