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 the nasolacrimal duct or the nasolacrimal gland (supratemporal) by bacteria or a virus that initiates the inflammation.

Dacryocystitis is infectious obstruction of nasolacrimal duct (inferomedial region)

  • On the exam you may be able to differentiate based on the location: Dacryocystitis will be medial.
  • Often caused by 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 nasal side of lower lid.

The diagnosis is based on clinical observation

Warm to cool compress

  • Infants often resolve, rarely need surgical correction

Dacryoadenitis with cannulation of the duct, stenting, surgery

Dacryocystitis with systemic antibiotics: Clindamycin + 3rd gen. cephalosporin

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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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