PANCE Blueprint EENT (7%)

Dacryoadenitis

Patient will present as → a 12-year-old with severe unilateral right eye pain and pressure. On physical exam, there is swelling, redness, tearing, and drainage from the outermost part of the affected right eye.

image-dacryoadenitis-and-dacryocystitis Dacryoadenitis is inflammation of lacrimal (tear-producing) glands usually caused by bacteria or a virus that initiates the inflammation

  • s/sx: unilateral severe pain, swelling, redness, tearing, drainage
  • Acute dacryoadenitis is most commonly due to viral or bacterial infection. Common causes include mumps, Epstein-Barr virus, staphylococcus, and gonococcus.
  • Chronic dacryoadenitis is most often due to noninfectious inflammatory disorders. Examples include sarcoidosis, thyroid eye disease, and orbital pseudotumor.
"On the boards you may be able to differentiate between the two based on the location: dacryocystitis will be medial. Remember medial = Center = dacroCystitis. vs. dacryoAdenitis which is up, up, and Away. Also it's important to note that dacryocystitis affects the duct and dacryoadenitis affects the gland."

Dacryocystitis is infectious obstruction of the nasolacrimal duct (inferomedial region)

  • Dacryocystitis will be medial ( remember "c" for central)
  • There will be an overflow of tears because the nasolacrimal duct is obstructed and there is nowhere for the fluid to exit
  • Often caused by a stone, debris, or dacryostenosis (would be seen in small children) = congenital malformation or failure of duct to open
  • Dacryoadenitis may lead to dacryocystitis and periorbital cellulitis if untreated – redness to the nasal side of the lower lid

The diagnosis of dacryocystitis and dacryoadenitis based on clinical observation

  • In cases of chronic dacryoadenitis, a CT or MRI of the orbits may be warranted
  • In acute cases of dacryocystitis, a Crigler, or tear duct massage can be performed to express material for culture and gram stain
  • In patients who appear to be acutely toxic or those who present with visual changes, imaging and bloodwork should be considered

Dacryoadenitis 

  • If the cause of dacryoadenitis is a viral condition such as mumps, simple rest and warm compresses may be all that is needed
  • For other causes, the treatment is specific to the causative disease

Dacryocystitis

  • Acute dacryocystitis (< 3 months) is treated with systemic antibiotics
  • Chronic dacryocystitis (> 3 months) typically presents with fewer inflammatory signs and requires surgical therapy for the underlying cause

Image created by Tova Goldstein

Question 1

A 7 month old female is brought to your clinic by his mother who reports the child has had swelling of the nasal corner of the left eye.  If left untreated what condition can develop?

A
Hyphema
Hint:
A hyphema is a collection of blood inside the front part of the eye (called the anterior chamber, between the cornea and the iris). The blood may cover part or all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye.
B
Papilledema
Hint:
Papilledema (or papilloedema) is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks.
C
pterygium
Hint:
a pterygium is an elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in inner corner/nasal side of they eye
D
dacryocystitis
Question 1 Explanation: 
Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. It may be a complication of untreated dacryoadenitis. Dacryocystitis may lead to failure to thrive.
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Lacrimal disorders (PEARLS) (Prev Lesson)
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