title: Clinical and microbiologic features of dacryocystitis-related orbital cellulitis.
abstract: Dacryocystitis-related orbital cellulitis is a relatively rare condition, and large case series of this clinical entity have been reported. This study was undertaken to identify a larger cohort of patients with this ailment, with the intent of defining its clinical and microbiologic features. Case logs from four institutions were reviewed to identify patients that suffered from dacryocystitis-related orbital cellulitis. A retrospective chart review was then performed to identify clinical features, management strategies, microbiologic features, and outcomes. A dedicated statistical software package was utilized to identify correlations between these variables. 13 patients (7 females, 6 males; mean age = 57.2 years, range = 7-89 years) were identified. One patient carried a diagnosis of immunosuppressive disease. All patients underwent emergent surgical drainage and received intravenous antibiotics. Primary acquired nasolacrimal duct obstruction was found to be the underlying etiology in nine cases (69.2%), whereas four patients suffered from specific causes of their obstructions. An average of 1.07 organisms/patient (standard deviation = 0.49 organisms/patient) were recovered from microbiologic cultures, and Gram-positive bacteria represented the majority of cultured organisms. All patients experienced either stable or improved vision upon discharge. The relationships between a specific etiology and the possibility of vision loss or the number of organisms cultured, between the number of organisms cultured and vision loss, and immunosuppression and vision loss or the number of organisms cultured were all not statistically significant (p > 0.05). Dacryocystitis-related orbital cellulitis most commonly occurs in adult patients who do not carry immunosuppressive diagnoses and suffer from primary obstructions. Multiple microbiologic species may cause this problem, although Gram-positive organisms are most common. With appropriate management, stable or improved vision can be achieved.
authors.affiliation: a Ophthalmic Plastic Surgery, Lions Eye Institute , Department of Ophthalmology, Albany Medical College , Albany , New York , USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Wladis
authors.affiliation: b Department of Ophthalmology , State University of New York-Downstate , New York , New York , USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Shinder
authors.affiliation: c Ophthalmic Plastic Surgery Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: LeFebvre
authors.affiliation: d Department of Ophthalmology , Kansas University , Prairie Village , Kansas , USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Sokol
authors.affiliation: d Department of Ophthalmology , Kansas University , Prairie Village , Kansas , USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Boyce
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D003131:Combined Modality Therapy; D003607:Dacryocystitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D054517:Orbital Cellulitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Dacryocystitis; lacrimal system; orbit; orbital cellulitis