Infected epidermoid cysts in the medial canthus can clinically mimic acute dacryocystitis, posing diagnostic challenges. The authors report the case of a 13-year-old male with a 2-month history of recurrent right medial canthal redness, swelling, pain, and purulent discharge. Initially misdiagnosed with acute dacryocystitis at another institution, he experienced symptom recurrence despite multiple incisions and drainage attempts. A comprehensive evaluation in our department, including history, physical exam, computed tomography dacryocystography, ultrasonography, and lacrimal endoscopy, was performed. The definitive diagnosis of an infected medial canthal epidermoid cyst was established histopathologically, followed by successful surgical management. This case underscores the principle that infection in the lacrimal sac region is not synonymous with dacryocystitis, emphasizing the necessity of a thorough, multidimensional diagnostic approach to prevent misdiagnosis and ensure timely, appropriate treatment.

Abstract Orbital roof fractures typically present in context of head injury and rarely present at the ophthalmology emergency department. We present 3 cases triaged to ophthalmology with orbital roof fractures as the primary pathology. First case is a 3-month-old boy with conjunctival chemosis, lid edema and dystopia 5 days after falling from couch. Initial CT scan revealed orbital subperiosteal collection and patient was cleared by neurosurgery. Drainage done by ophthalmology revealed CSF leak. CT scan was repeated showed hairline skull base fracture through which CSF accumulated in the subperiosteal space. Leak was managed medically and stopped spontaneously. Second case is a 7-year-old boy referred to ophthalmology for evaluation of rupture globe and lid wound. Upon evaluation, brain tissue was found in orbit. CT scan revealed large roof fracture with brain herniation. Patient was referred to neurosurgery for further management. Lid wound repair was done at a later stage after patient stabilization. Third case is an 8-year-old boy with an acute inner canthal swelling clinically diagnosed as acute dacryocystitis. He had major trauma at the age of four with multiple facial fractures. Recent MRI revealed orbital encephalocele herniating through old roof fracture. DCR was performed with neurosurgery present as an extra precaution in case of encephalocele injury.

Acute neonatal dacryocystitis (AND) is a common ocular emergency in neonates, often associated with dacryocystocele. It typically presents with inflammatory swelling in the medial canthal region and can lead to serious complications if untreated.

Modern science states that lacrimal sac inflammation combined with nasolacrimal duct blockage results in tear stasis and secretion buildup in the sac,which makes the sac more vulnerable to bacterial colonization and dacryocystitis1 According to Ayurveda it can be taken as Pooyalasa, characterised by suppurated swelling in the Kanininka sandhi (inner canthus). This case study includes an 8year old boy presented to our OPD with swelling in the medial canthus associated with pus discharge and mild fever. Ayurvedic treatments were administered, including Karutha Vatt and Mukkadi Lepanam over the nose, cheek, and around the eyes,triphala Kashaya sekam,Rajanyadi Choornam,Kombanchadi and Gopichandanadi gulika, Pippalyasavam and Krimigna Vati. After 14 days of treatment, patient was relieved from all the symptoms. This case study demonstrates how ayurvedic remedies can be used to treat Pooyalasa, especially in paediatric patients. External and internal treatments worked well together to reduce symptoms and encourage healing. The positive result in this instance highlights how crucial it is to incorporate ayurvedic methods into the management of dacryocystitis, providing a comprehensive and supplementary substitute for traditional medical procedures.

Pilomatrixoma is a rare benign tumor originating from hair follicle matrix. It is commonly misdiagnosed clinically. The authors present an unusual case of a Pilomatrixoma in a young adult with epiphora mimicking dacryocystitis. An 18-year-old female presented with right eye tearing and nodular mass (12 mm × 10 mm) localized under the medial canthal tendon, resembling acute dacryocystitis for 2 months. Following 1-week oral antibiotic treatment, nasolacrimal duct obstruction was detected with lacrimal irrigation. On palpation, the mass was nontender, painless, reddish in color, and hard in consistency. The lesion was completely removed and external dacryocystorhinostomy was performed. Histopathological examination revealed basaloid and shadow cells accompanied by calcification and foreign body giant cells. These findings were diagnostic of pilomatrixoma. At the 6-month follow-up, the patient had no recurrence or epiphora. Pilomatrixoma can present with epiphora, simulating lacrimal sac inflammation. Complete excision is curative, and diagnosis can generally be established by histopathological examination.

ABSTRACT Purpose To provide Australian data and a literature review on the clinical, radiological, and microbiological features and outcomes in patients with orbital abscess secondary to dacryocystitis. Methods Multicentre retrospective review of orbital abscess secondary to acute dacryocystitis from 2019 to 2024 in Australia. Results Eight cases were identified. The median age was 56 years (range, 26–80 years) with no gender predilection. Common presenting symptoms and signs were motility restriction (n = 6, 75%), proptosis (n = 5, 62.5%), decreased visual acuity (n = 4, 50%), chemosis (n = 3, 37.5%) and RAPD (n = 2, 25%). Radiologically inferomedial (n = 3, 37.5%) and medial (n = 2, 25%) orbital involvement was most commonly followed by intraconal (n = 2, 25%) and inferior (n = 1, 12.5%) orbit. Microbiological cultures revealed gram-negative bacteria (n = 3), gram-positive bacteria (n = 1), anaerobic growth (n = 1), polymicrobial growth (n = 1), MRSA (n = 1), and no growth (n = 1). Treatment included intravenous antibiotics in all cases, 4 patients underwent orbital abscess drainage combined with DCR, 1 had orbital drainage alone, 1 had endoscopic DCR alone, 1 had canthotomy with cantholysis, and 1 patient did not receive surgical treatment. One patient lost vision (light perception) with remainder having stable or improved visual acuity at follow up. Conclusion Acute surgical management needs to be considered in majority of cases with dacryocystitis and orbital abscess. Signs of orbital involvement in acute dacryocystitis should be identified promptly to prevent irreversible visual loss.

Abstract Neonatal dacryocystocele is a rare anomaly resulting from dilation of the lacrimal sac and duct due to congenital nasolacrimal duct obstruction, commonly referred to as congenital dacryostenosis. Although it can resolve spontaneously, it may rarely lead to potentially serious complications such as acute dacryocystitis or nasal respiratory distress, necessitating specialist consultation (ophthalmology and/or ENT) and further laboratory and imaging studies. We report a case of acute dacryocystitis in a newborn with a congenital dacryocystocele who presented since birth with a painful swelling at the left medial canthus, associated with epiphora and nasal discharge. Following an initial ultrasound, CT imaging revealed a soft tissue lesion in the medial canthal region and a left dacryocystocele extending into the nasal fossa that had progressed to acute dacryocystitis. The patient was hospitalized for intravenous antibiotic therapy followed by probing of the nasolacrimal drainage system. This case highlights the importance of prompt diagnosis and appropriate management of nasolacrimal duct anomalies such as complicated dacryocystocele.

A 30-year-old female with no significant past medical or ocular history presented to a tertiary emergency department with left acute dacryocystitis and preseptal cellulitis that was refractory to topical and oral antibiotic therapy commenced in the community. Lacrimal sac aspiration identified presence of Hafnia alvei. She was successfully treated with dual intravenous antibiotic therapy and without systemic steroids, and an endonasal dacryocystorhinostomy was performed following the acute infection. No disease recurrence occurred during follow-up. This unusual case of H. alvei dacryocystitis and preseptal cellulitis highlights an ever-increasing bacterial spectrum and a need to consider previously unreported pathogens as causative organisms of acute dacryocystitis.

Ayurveda describes Pooyalasa as one of the Sandhigata Netra Rogas, characterized by pus discharge, swelling, and pain in the kaninaka sandhi (medial canthus). This condition can be correlated with Acute Dacryocystitis, an acute suppurative inflammation of the lacrimal sac, characterized by pain and swelling in the lacrimal sac region. Conventional treatments for Acute Dacryocystitis include antibiotics, analgesics, anti-inflammatory drugs, drainage of lacrimal abscesses, and Surgical interventions like DCT and DCR operations. In this case study, a 60-year-old female patient presented with a history of watering and pus discharge from her left eye for one year, followed by swelling and pain for three days, and abscess formation with pus collection for one day. She was treated with a combination of external and internal Ayurvedic interventions. External treatments include Kshalana with Triphala kashaya, Lepana with Karuthavattu gulika and Triphala kashaya, Bidalakam with Mukkadichoornam and Triphala kashaya for 5 days, and Prathimarsha Nasya with Eladi keram and Saindavam for 5 days. Internal treatments include Kaisoraguggulu,Guggulu panchapala tablet, Chandraprabha vati, Guduchyadi kashaya, and Manjishtadi kashaya. The patient showed significant improvement, demonstrating the effectiveness of Ayurvedic interventions in managing Pooyalasa (Acute Dacryocystitis).

Acute dacryocystitis (AD) is primarily related to nasolacrimal duct obstruction and is associated with a high morbidity, particularly in the elderly. This study aims to determine patient-related and weather-related risk factors of developing AD in adults with and without primary acquired nasolacrimal duct obstruction (PANDO). Retrospective single-centre observational study of all adult patients with a clinical diagnosis of AD between January 2000 and February 2020. The monthly average of air temperature, air humidity, air pressure and precipitation was collected from the Royal Meteorological Institute of Belgium over the same 20-year time period. Patients had a PANDO, non-PANDO or uncategorised status based on available data on lacrimal syringing. The study comprised 106 patients with first-onset AD, of whom 86 (81%) were female and 20 (19%) male, with a mean age of 64.9 years. PANDO was found in 50% of the patients, non-PANDO in 20% and 30% could not be categorised. The incidence of AD was overall significantly associated with age, with an increase of 14.5% for every 5-year age increase (p=0.012, Exp(B)=1.145). In particular, in the PANDO group, the risk increased by 22.1% for every 5-year age increase (p<0.002, Exp(B)=1.221). This association was not evident in the non-PANDO group. There was no significant association between the incidence of AD and any of the weather variables. AD is more common in women and the risk of development increases significantly with ageing, especially when underlying PANDO is present. This risk assessment can be useful in the counselling of elderly female patients with symptomatic PANDO about AD-preventive dacryocystorhinostomy.

To investigate the clinical profile and endoscopic dacryocystorhinostomy (En-DCR) outcomes in patients with acute dacryocystitis (AD) caused by prolonged placement of nasolacrimal duct stent (NDS). This investigation retrospectively reviewed the medical eye records of 15 patients with AD caused by the infection due to long-term NDS use in the lacrimal drainage system. The patient cohort was selected from June 2019 to February 2023. All the cases were treated with En-DCR with bi-canalicular silicone tube intubation, and the incarcerated stents were removed during the surgeries. Furthermore, patient's demographic data, clinical profiles, and treatment outcomes were recorded. This research included 4 males and 11 females with an average age of 62.87 ± 7.58 years (48-76). Furthermore, it was observed that the time between the NDS intubation and AD occurrence was from 1.5 to 26 years. The time between AD initiation and En-DCR surgeries was 5 to 40 days. All patients presented with clinical manifestations of AD, and 4 patients had a cutaneous fistula. In addition, all patients underwent En-DCR, and the incarcerated stents were successfully removed. After a year of follow-up, the anatomic and functional success rate was 86.67% (13/15). The failure observed in 2 cases was because the scarring caused intranasal ostial closure. In addition, acute inflammation completely resolved in all the patients without recurrence. Long-term NDS use can induce AD onset, which needs clinical attention. En-DCR is an effective treatment for AD secondary to nasolacrimal stent intubation.

Infected Gelfoam® and postoperative acute dacryocystitis

Dear Editor, In February 2023, the Revista Brasileira de Oftalmologia published a case of congenital bilateral dacryocystocele, by Pierre-Filho et al.() and I would like to congratulate the authors for raising this important topic. The article describes a child who presented with bilateral bluish enlargement of the lacrimal sacs from birth, along with tearing, which typically begins between the first and second week of age.(,) […] Comments to: Bilateral congenital dacryocystocele complicated with acute dacryocystitis

Purpose: We report the diagnosis and conservative treatment of a patient with dacryocystitis accompanied by a congenital lacrimal sac diverticulum.Case summary: An 11-year-old boy presented with itching and redness in his right eye. His best-corrected visual acuity was 0.8 in the right eye and 1.2 in the left. Physical examination revealed redness, swelling, and tenderness around the right lacrimal sac area. Probing of the nasolacrimal duct showed no obstruction. Additional tests were performed under the diagnosis of acute dacryocystitis. Computed tomography and magnetic resonance imaging suggested inflammation of the soft tissue with abscess formation around the right orbit, with inflammation extending to the lower eyelid. After 7 days of inpatient treatment, the symptoms improved. Dacryocystography performed after the symptoms improved showed a small amount of residual contrast in a space near the lacrimal sac, leading to the diagnosis of a right lacrimal sac diverticulum.Conclusions: In patients with dacryocystitis without nasolacrimal duct obstruction, congenital lacrimal diverticulum should be suspected.

Dacryocystitis is an inflammatory condition of the lacrimal sac, often presenting with pain, swelling, and purulent discharge, primarily due to nasolacrimal duct obstruction. In Ayurveda, the condition is analogous to Pooyalasa, a chronic and recurrent pathology affecting the lacrimal apparatus. If untreated, it can lead to complications such as abscess formation, fistula, and systemic infections, emphasizing the need for timely and systematic management. This case report discusses a 48-year-old male presenting with a 3-month history of epiphora and purulent discharge from the right eye, progressing to acute painful swelling and associated systemic symptoms. The case was diagnosed as Pooyalasa in the stage of lacrimal abscess formation, based on clinical signs and symptoms. Treatment involved a combination of internal Ayurvedic formulations such as Patoladi Kashaya, Kaisora Guggulu, and Panchatikta Kashaya for their anti-inflammatory, immune-modulatory, and wound-healing properties. External therapies included Triphala Kashaya Kshalana for cleansing and Karuthavattu Lepana for localized anti-inflammatory and decongestant effects. The integrated Ayurvedic intervention led to complete resolution of symptoms, healing of the lacrimal abscess, and prevention of recurrence during follow-up. This case underscores the efficacy of Ayurvedic principles in managing Pooyalasa by addressing the pathogenesis holistically, focusing on both local and systemic healing. Further clinical studies are recommended to evaluate the broader applicability of Ayurvedic protocols in the management of lacrimal sac disorders.

To compare the nasolacrimal and nasal anatomical parameters in cases of acquired primary nasolacrimal duct obstruction and acute dacryocystitis. The study included 62 eyes of 31 patients. The eyes were divided into three groups: Group A, comprising eyes presenting with acute dacryocystitis; Group B, comprising eyes with nasolacrimal duct obstruction but no previous episodes of dacryocystitis; and Group C, comprising eyes with an patent nasolacrimal duct. The coronal, axial, and sagittal computed tomography images of the cases were examined to assess parameters such as the canal's entry and exit, the narrowest transverse and anteroposterior diameters, the anatomical type of the canal, inferior turbinate thickness, the angle between the inferior turbinate and the medial maxillary wall, and the direction of septal deviation. No significant difference was found in any parameter when comparing eyes with acquired primary nasolacrimal duct obstruction to the contralateral eyes without obstruction (p > 0.05). Among the three groups, eyes with acute dacryocystitis (Group A) had significantly wider exit transverse and narrowest anteroposterior diameters compared to the other two groups (p = 0.000, p = 0.001, and p = 0.006, p = 0.042), with the narrowest transverse diameter also being significantly wider compared to Group B (p = 0.007). The angle of the inferior turbinate was significantly lower in Group A compared to Group B (p = 0.038). There was no significant difference between the groups regarding the anatomical type of the canal (p = 0.981). While anatomical parameters do not show significant differences between eyes with primary acquired nasolacrimal duct obstruction and those without obstruction in the same individual, the wider canal diameters in eyes with acute dacryocystitis suggest that secondary changes associated with dacryocystitis or a predisposition to dacryocystitis might be present in eyes with nasolacrimal duct obstruction.

Acute dacryocystitis in children with mononucleosis

BACKGROUND Infantile acute dacryocystitis is due to congenital nasolacrimal duct obstruction (NLDO) in newborns and infants, which involves acute bacterial infection of the lacrimal sac. This report describes a 37-day-old male infant with acute dacryocystitis and lacrimal abscess managed with a modified decompression and nasolacrimal duct probing. CASE REPORT We report the case of a 37-day-old male infant who presented with acute dacryocystitis complicated by a giant lacrimal abscess. On day 30 of life, his parent brought him to a local clinic due to inferior eyelid edema and hyperemia. He was diagnosed with acute dacryocystitis and was treated with tobramycin eye drops and ointment. However, severe erythema, swelling, and tenderness over the lacrimal sac area persisted. The parent refused a head CT, ultrasound examination, and systemic antibiotics, and brought the infant to our emergency unit for a second opinion on day 37 of life. A modified decompression and probing approach was employed, which involved gentle decompression of the abscess to relieve tension, followed by probing of the nasolacrimal duct to restore proper drainage. After a repeat decompression and probing procedure, the dacryocystitis and giant lacrimal abscess disappeared gradually, with good esthetic results. The infant responded well to the treatment, with resolution of symptoms and no recurrence of the abscess during follow-up. CONCLUSIONS This case demonstrates that our modified decompression and probing approach provides a practical and an alternate option to treat acute dacryocystitis in infants complicated by a giant lacrimal abscess.

Congenital dacryocystoceles are a rare condition caused by nasolacrimal duct obstruction. Symptoms include epiphora, nasal obstruction, and swelling in the medial canthus. Treatment usually entails probing Hasner's valve open and, if necessary, intubating the nasolacrimal duct. We present a minimally invasive, endoscopic procedure with marsupialisation of the endonasal portion of the cele. The operation avoids additional manipulation of the lacrimal duct to prevent iatrogenic injury. This retrospective analysis included a total of nineteen infants or young children (21 eyes) aged 3 days to 39 months. Two of the patients were suffering from acute respiratory distress, seven from recurrent infections with persistent epiphora, and twelve from acute dacryocystitis with orbital phlegmon. The endonasal portion of the dacryocele was detected in all cases and resected endonasally using an endoscope. Recurrences required revision surgery involving dacryocystorhinostomy after primary surgery in two patients aged of 22 and 39 months. All other seventeen patients were free of recurrence. Our results show endoscopic endonasal marsupialisation without additional intubation or probing of the lacrimal ducts to be a successful treatment strategy for congenital dacryocystoceles. This avoids iatrogenic scarring, false passages, or postoperative bacteraemia. The surgical technique presented here shows a lower success rate in older children with a history of inflammation.

ObjectiveTo observe the clinical of endoscopic-assisted lacrimal duct probing in neonates with acute dacryocystitis. MethodsThe prospective treatment of 148 eyes of 103 cases of neonatal acute dacryocystitis was studied. In the observation group, 58 cases (76 eyes) underwent endoscopic exploration of lacrimal passage under topical anesthesia. Make the child lie on the bed, after the surface anesthesia of hydroxybucaine hydrochloride, dot dilator is not easy to expose the dilatable lower point. With the assistance of nasal endoscope, the probe of the No. 6 lateral foramina lacrimal duct entered the lacrimal duct and dacryocyst successively. After entering the dacryocyst, the pus was sucked out with a syringe and rinsed repeatedly with normal saline until no obvious suppurative secretions were discharged. Postoperative topical anti-inflammatory eye drops and oral antibiotics were used. In the control group, 45 patients (72 eyes) were treated with hospitalized systemic antibiotics and conservative treatment with local antibiotic eye drops. ResultsIn the observation group, 58 cases (76 eyes) underwent superficial anesthesia and nasal endoscopy assisted lacrimal duct exploration and achieved satisfactory results. Stenosis of the lower nasal passage was found in one eye. In all cases, there were no serious complications during and after surgery, and no recurrence was observed for 3 months to 1 year after surgery. In the control group, 45 cases (72 eyes) of neonates with acute dacryocystitis, 10 cases with conjunctival sac secretion disappeared after conservative treatment. Redness and swelling in the dacryocystitis were improved in 31 cases, of which 2 cases had facial scars due to drainage of pus from the conjunctiva sac through a percutaneous laceration incision. Four patients were discharged automatically due to the aggravation of symptoms. After 6 months of follow-up, about 50% of the children received exploratory treatment of lacrimal passage and completely healed. ConclusionNasal endoscope-assisted dacryocystitis is a method for the treatment of neonatal acute dacryocystitis, which is worthy of clinical promotion.