Recognition and Management of Acute Dacryocystic Retention

Dacryocystitis in a Patent Nasolacrimal Drainage System: A Literature Review

INTRODUCTION

Acute dacryocystitis is an acute infection and the lacrimal sac secondary to pathogenic microorganism growth within the stagnant fluid in the lacrimal sac secondary to nasolacrimal duct obstruction.

METHODS

A literature review was conducted on the PubMed database using the following search terms "dacryocystic retention" and "dacryocystitis" or "dacryolith" or "lacrimal duct" or "pseudo-dacryocystitis".

RESULTS

The literature review suggests that dacryocystitis in a patent nasolacrimal drainage system can stem from diverse causes including the mechanical impaction by dacryoliths, viral infections and anatomical variations. It is believed that these causes lead to transient obstruction to the nasolacrimal excretory system predisposing to secondary infections. Idiopathic temporary dacryocystic retention is also highlighted in this review.

CONCLUSIONS

This review broadens the understanding of dacryocystic retention and highlights the need for careful diagnosis and tailored treatment plans, particularly in cases deviating from the traditional etiological pathways.

Epstein-Barr Virus-Associated Acute Dacryocystic Retention

Epstein-Barr virus (EBV) associated dacryocystic retention presents with an acute swelling in the lacrimal sac area with epiphora and lymphadenopathy. The patient would usually have a preceding history of infectious mononucleosis with clinical features of fever, pharyngitis, preauricular and cervical lymphadenopathy, hepatosplenomegaly, subclinical hepatitis, nausea, and palatine petechiae. The present case is of a 3-year-old child who presented with a sudden painless swelling in the lacrimal sac region with epiphora. Investigations and a biopsy helped in establishing the diagnosis of EBV-associated dacryocystic retention which resolved completely with conservative management.

Acute dacryocystitis retention syndrome due to Epstein-Barr virus

A 4 year-old boy with no previous history of eye or nasolacrimal disease was referred due to a painful mass on his left inner canthus, of three days onset, with no improvement in spite of oral antibiotics. On examination eyelid oedema with periocular hyperaemia was noted. Lacrimal sac palpation was painful and tonsillar exudation was reported. He was admitted and started on intravenous (iv) antibiotics. Four days later, lacrimal signs started to improve, but his general condition become worse. Head and neck Computed Tomography scan (CT scan) showed a left lacrimal sac enlargement, suggestive of acute dacryocystitis and swollen laterocervical lymph nodes. Epstein Barr Virus (EBV) serology and PCR testing were positive. The child responded well after eight days, and was discharged with oral antibiotics. Acute dacryocystic retention (ADR) associated with EBV was suspected. Six months later, the patient remained asymptomatic with no tearing or other lacrimal symptoms.