Which physical findings are characteristic of dacryocystitis?

Updated: Oct 08, 2019
  • Author: Grant D Gilliland, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Answer

Purulent reflux with medial canthal massage is a classic sign of dacryocystitis but is not present in all cases. Nasolacrimal irrigation should not be performed in patients with obvious mucoid reflux.

Fever results from a fulminant bacterial or fungal infection in the lacrimal sac, which spreads to the surrounding tissues. This is not uncommonly associated with significant sinus disease, and there may be accompanying leukocytosis.

Cellulitis surrounding the affected lacrimal sac is common in patients with acute dacryocystitis. This can spread to involve the orbit and cause orbital cellulitis.

Altered visual acuity most frequently is caused by an abnormal tear film with abnormal refraction of light at the air-tear film interface. It also can be due to corneal surface irregularities resulting from chronic surface inflammation.

Altered pupillary reaction is only seen in severe cases of dacryocystitis associated with an orbital cellulitis. This is due to increased intraorbital pressure and necrosis of the pupillomotor fibers in the orbit.

Diplopia is also rare and is seen in patients with orbital cellulitis resulting from acute dacryocystitis. These patients have orbital inflammation involving the extraocular muscles, which causes the muscles to dysfunction, resulting in diplopia.

Loss of peripheral vision is also rare and caused by orbital cellulitis secondary to acute dacryocystitis. This results in an optic neuropathy with loss of peripheral vision. Many times, this can be subtle and can be detected on perimetry testing.

Conjunctivitis frequently is associated with acute and chronic dacryocystitis. It is primarily due to the buildup of toxic debris on the surface of the eye, including the exotoxin produced by staphylococcal organisms, which normally inhabit the surface of the eye.

Medial canthal fullness and tenderness are common in both acute dacryocystitis and chronic dacryocystitis, which is due to distention of the lacrimal sac and resultant infection of the lacrimal sac. Dacryocystitis usually does not extend above the medial canthal tendon, and the medial canthal swelling should not be pulsatile. Rarely, an occult tumor or cyst can be the cause of the medial canthal fullness.

Tearing is most commonly due to obstructed outflow of the tear system but may be exacerbated by conjunctivitis. Rarely, patients with acute or chronic dacryocystitis have no complaints of tearing but have other sequelae of tear sac infection, including redness, cellulitis, pain, fullness, and purulent discharge.


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