Search

Background: We present a series of patients with acute suppurative bacterial dacryoadenitis and review the clinical presentation, microbiology, treatment options and outcome., Methods: A multicentre, retrospective, case series review of patients with a clinical diagnosis of acute bacterial suppurative dacryoadenitis (ASBD). Records were examined to obtain information regarding patient demographics, presenting symptoms and signs, radiology, microbiology, management, outcomes and follow-up., Results: 11 patients (9 men, 2 women; mean age 43.9 years, range: 6-82 years) were included. Average time to presentation was 2.8 days, and predisposing conditions were found in 45% of cases. Common presenting symptoms were eyelid swelling, pain, redness and diplopia, and common signs were ptosis, discharge and restriction of eye movements. The most common causative bacteria were Staphylococcus aureus and skin flora. Lacrimal gland swelling was universally seen on CT, with globe indentation of displacement in 27% of cases. Intravenous antibiotics were used in 91% of cases, which subsequently resolved over an average period of 9.7 days. Those with abscess formation (n=2) required incision and drainage., Conclusions: ASBD is a rare condition that resolves quickly if managed appropriately. Underlying anatomical, infectious or inflammatory conditions should be investigated, and skin commensals should be covered with the instigation of antibiotic therapy.

A 41-year-old woman presented with painful swelling of the lateral aspect of the right upper lid along with ipsilateral conjunctival injection. Her right eye had limited abduction and pain on attempted lateral gaze. Funduscopy was normal. Medical history included Crohn's disease treated with sulphasalazine and azathioprine. White blood cell count, erythrocyte sedimentation rate and C reactive protein were raised. CT of orbits revealed right-sided lacrimal gland enlargement, with signs of abscess formation within it. She was treated initially with intravenous antibiotics for 3 days and then switched to orals but it took 2 weeks for full resolution of symptoms. Eight months later, she presented again with signs of acute left-sided dacryoadenitis, not responding at all to oral antibiotics after 3 days. She was subsequently started on oral steroids, and her symptoms resolved within 48 h. Steroids were tapered without any recurrence after a period of 6 months.

A 48-year-old Filipino female presented with unilateral acute onset painful red eye, blurred vision and yellow discharge. On examination she had a corrected visual acuity of 6/5 in the right eye and 6/18 in the left eye. There was a left-sided periorbital swelling, with chemosis involving the bulbar conjunctiva on the temporal aspect. Ocular motility showed limitation of left-sided abduction with mild limitation of laevoelevation and laevodepression. She was afebrile and systemic examination was unremarkable. Medical history included diagnosis of Crohn's disease since the age of 20. She was on oral mesalamine 1 g for mildly active colitis. Full blood count was normal but erythrocyte sedimentation rate and C reactive protein were raised. Blood culture and conjunctival swab were negative. Contrast-enhanced CT scan demonstrated enlargement of the lacrimal gland. She was managed conservatively with acetaminophen and codeine for pain and swelling. She recovered completely in 2 weeks with no sequelae.

A case of infectious mononucleosis presenting as bilateral acute dacryocystitis in a 7-year-old girl is reported. Acute dacryocystitis is uncommon in this age group, and an underlying systemic illness should be suspected particularly when it is bilateral.

A 65-year-old man developed canaliculitis first of the left lower and later of the left upper lacrimal canaliculus. Mucoid material expressed from the upper canaliculus grew a pure culture of Enterobacter cloacae, the colonies of which had a stringy, tenacious, mucoid property consistent with the clinical findings. Treatment with topical chloramphenicol and oral ampicillin was followed by complete resolution.

The microbial flora of 738 patients with acute bacterial conjunctivitis, corneal ulceration, blepharitis, dacryocystitis, and discharging sockets has been investigated. Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae were the main pathogens isolated. Str. viridans was associated with conjunctivitis in patients aged under 1 year. moraxella sp. was isolated on only one occasion. Overall, 40% of specimens were associated with Staph. epidermidis or mixed skin flora, which also occurred with cultures of the normal eye. Clostridium welchii was isolated on 3 occasions but was not associated with bullae or gas gangrene. The least overall resistance, of 6%, was to chloramphenicol, but no one antibiotic was effective against all pathogens. Gentamicin remains the antibiotic of choice for Pseudomonas aeruginosa infection.