What is the role of infection in the etiology of dacryocystitis?

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

Approximately 50% of patients undergoing surgery for dacryocystitis have positive culture results; of these, pure cultures are obtained in 71% of them, with mixed cultures in the remaining 29% of patients.

The bacteriology of dacryocystitis mimics normal conjunctival flora in most instances, as follows:

  • The most common aerobic organisms isolated from the lacrimal sacs in adults with dacryocystitis include S epidermidis, S aureus, and Streptococcus, Pseudomonas, and Pneumococcus species. S epidermidis is the most common isolate followed by S aureus.
  • Among MRSA-positive isolates, 71.8% are associated with the formation of a biofilm.
  • The most common anaerobic organisms isolated from the lacrimal sacs in adults with dacryocystitis include Peptostreptococcus, Propionibacterium, Prevotella, and Fusobacterium species.
  • Gram-negative bacteria have been reported to occur more frequently in patients with copious discharge. The most common gram-negative bacteria isolated were E coli.
  • Gram-negative organisms account for 27% of the cultured organisms, with P aeruginosa and E coli being the most common.
  • Some studies have found Pneumococcus to be the most common isolate in dacryocystitis.
  • Rarely, fungi have been isolated from infected lacrimal sacs (commonly associated with dacryolith formation).

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