Ch 37. Dacryoadenitis, Dacryocystitis, and Canaliculitis Flashcards
How is the lacrymal gland imaged in a CT scan of a patient with dacrioadenitis?
Enlarged, with indistinct margins, but no bony defect.
Initial management of infectious dacryoadenitis?
cefalexin 250-1gr QID, clindamycin 150–300 mg orally every 6 hours or erythromycin 500 mg orally four times a day
Plus culture of the conjunctival secretion
A patient presents with a temporal, upper eyelid, inflammation; s-shaped eyelid sign, temporal upper conjunctival chemosis, and mild malaise.
You are not sure if the patient has an infectious or non-infectious process.
What is the right way to proceed?
Acute infectious, non-infectios dacryoadenitis and orbital pseudotumor, may be clinically identical.
If there is doubt about whether one is dealing with an infectious or a noninfectious process, it may be preferable to treat the patient with an antibiotic over the first 24–48 hours in conjunction with pain relievers. If there is little or no improvement at this time, a biopsy is required to confirm the diagnosis followed by a course of corticosteroids. Nonspecific idiopathic orbital inflammation involving the lacrimal gland is generally quite sensitive to oral steroids1,10,12 and should show a response within 24 hours.
Is Dacryocystocele a medical emergency?
It is not… nevertheless, it can turn into one.
Infants are obligate nasal breathers, therefore, treat dacryocystocele conservatively with massage for 2-3weeks. If it does not resolve, becomes infected or if there are ANY signs of breathing difficulty, ATBs + DCR must be performed.
Management of acute dacryocistitits in the newborn?
Hospitalization for IV cefuroxime (newborn,30–100 mg/kg per day in two divided doses; and infants, 1 month to 12 years, 30–100 mg/kg per day in three to four divided doses
Are antibiotics curative for acute dacryocystitis?
They do treat the infectious process, but patients often require surgery to correct the obstruction resulting from secondary scarring.
