title: Methicillin-resistant Staphylococcus aureus dacryoadenitis.
abstract: OBJECTIVE
  Although classically thought to be primarily a nosocomial infection, the incidence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is rising. In this series we report 3 cases of community-acquired MRSA acute dacryoadenitis in adults presenting within a 3-week period.
  
  
  METHODS
  All cases presented with pain and periocular erythema increasing over approximately 1 week. An S-shaped lid deformity was evident, and 2 of the 3 cases demonstrated multiple pustules/abscesses in the region of the lacrimal gland that were expressing purulent fluid into the superior fornix. Eye cultures yielded MRSA. Each case had complete clinical resolution with 2 to 4 days of intravenous vancomycin followed by 1 week of oral trimethoprim-sulfamethoxazole combination therapy.
  
  
  CONCLUSIONS
  These cases underscore the changing profile of MRSA infections, especially in the community-based setting. MRSA dacryoadenitis can be difficult to treat with standard therapeutic approaches and may progress to orbital cellulitis. We recommend a short admission for intravenous antibiotic therapy while bacterial sensitivities are being determined before transitioning to a dual-targeted oral antibiotic regimen.
authors.affiliation: Division of Orbital and Oculoplastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles.
authors.forename: Wenjing
authors.initials: W
authors.lastname: Liu
authors.affiliation: Division of Orbital and Oculoplastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Rootman
authors.affiliation: Department of Ophthalmology, Children's Hospital, Los Angeles, California.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Berry
authors.affiliation: Division of Orbital and Oculoplastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Hwang
authors.affiliation: Division of Orbital and Oculoplastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Goldberg
mesh_terms: D000208:Acute Disease; D000328:Adult; D003607:Dacryocystitis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D013203:Staphylococcal Infections / Q000188:drug therapy*