A REPERTOIRE OF ACUTE DACRYOCYSTITIS

Background: Clinical features of acute dacryocystitis comprise of three stages- stage of cellulitis, lacrimal abscess and fistula formation. Infective odontogenic focus is one of the known etiologies for acute dacryocystitis. Pre-septal cellulitis is the most common presentation associated with epiphora. Tenacious inflammation of sac or distal nasolacrimal duct obstruction can result in a lacrimal abscess. Unattended abscess may consequently form a fistula. Acute dacryocystitis rarely can get complicated to cause orbital cellulitis overstriding the anatomic barriers. Case Presentation: Case1: A 72/F complained of toothache since a week, followed by diffuse swelling below lower eyelid, pain and discharge near medial canthus. The case was diagnosed as acute dacryocystitis with pre-septal cellulitis due to apical abscess of right maxillary molar which was visualised on orthopantomogram. Case2: A 36/M presented with mild pre-septal cellulitis and lacrimal abscess. Case3: A 79/M presented with diminution of vision, pain and inability to move the right eye. He had history of watering for8 years. He was diagnosed to have orbital cellulitis with fistula secondary to acute on chronic dacryocystitis. Discussion: Case 1: Symptoms resolved spontaneously with emergency access opening of right first maxillary molar and systemic intravenous broad-spectrum antibiotics. She further underwent dacryocystectomy with fistulectomy. Case 2: Lacrimal abscess was managed with incision and drainage followed by dacryocystorhinostomy. Case 3: Orbital cellulitis was managed with broad-spectrum intravenous antibiotics. Dacryocystectomy with fistulectomy was performed after the eye was quiet. Conclusion: Presentation of dacryocystitis can have variable causes hence proper history and addressing underlying cause at the earliest can help in early resolution. Aggressive management of complications can help in steady subsidence without progression.