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Dacryocystitis 237.e1

Dacryocystitis Client Education
Sheet
VetBooks.ir Diseases and Disorders

DIAGNOSIS
• Gently insert cannula or intravenous catheter
BASIC INFORMATION
(stylet removed; 22-24 gauge for dogs;
Definition Diagnostic Overview 24-26 gauge for cats), with 3-mL syringe
Although dacryocystitis is inflammation of the Suspicion for the diagnosis is based on chief filled with sterile saline or eyewash attached,
lacrimal sac, the term is commonly used to complaint and physical exam findings indica- approximately 3 mm into the dorsal lacrimal
describe inflammation anywhere along the tear tive of ocular abnormalities, including ocular punctum.
drainage (i.e., nasolacrimal) system, including discharge. Determination of whether dacryo- • Slowly inject the saline/eyewash until it
the lacrimal puncta, canaliculi, lacrimal sac, and cystitis involves an obstruction or is secondary flows from the ventral lacrimal punctum
nasolacrimal duct. Dacryocystitis is an acquired to inflammation is the key to diagnosis and (confirms puncta, canaliculi, and lacrimal
condition resulting in ocular discharge. prompt treatment. This is accomplished by sac are patent).
checking for nasolacrimal passage of fluorescein • Next, occlude ventral lacrimal punctum with
Epidemiology dye and nasolacrimal flushing. digital pressure and flush 3-12 mL saline/
SPECIES, AGE, SEX eyewash through the nasolacrimal duct.
Dogs and cats; no age or sex predisposition Differential Diagnosis • Collect fluid/discharge at naris in sterile
Other causes of blockage of the nasolacrimal basin.
GENETICS, BREED PREDISPOSITION system: • Culture and sensitivity testing of purulent
• Brachycephalic breeds (lacrimal stasis): most • Congenital disorders, including micropunc- discharge if present
common conformation associated with tum or imperforate lacrimal punctum • Consider referral to a veterinary ophthal-
dacryocystitis • Acquired disorders, including traumatic mologist if unable to establish patency of
• Some extremely dolichocephalic breeds (e.g., lacerations or neoplastic invasion or compres- nasolacrimal system.
Doberman pinschers, collies) also have poor sion of the nasolacrimal drainage apparatus
tear drainage and stasis due to a small, deeply Other causes of ocular discharge (p. 703) Advanced or Confirmatory Testing
set eye and loss of eye-to-lid contact in the • Dacryocystorhinography (contrast study
medial canthal area. Initial Database of nasolacrimal system) with standard
Complete ophthalmic exam (p. 1137): radiography can identify an obstruction site.
RISK FACTORS • Schirmer tear test (rule out keratoconjunctivi- • CT or MRI dacryocystorhinography allows
• The most common causes of dacryocystitis in tis sicca [KCS] as cause for ocular discharge). highly accurate characterization of lesions
dogs and cats are foreign bodies (e.g., plant Normal > 15 mm after 1 minute in dogs, obstructing the nasolacrimal duct.
awns that become lodged in the nasolacrimal varies in cats.
system) and descending infections due to • Fluorescein dye application TREATMENT
poor conformation and subsequent lacrimal ○ Rule out corneal ulceration as cause for
stasis. ocular discharge. Treatment Overview
• Animals that spend time outdoors are at ○ Fluorescein dye application also tests for Determine character (e.g., plant material,
increased risk. nasolacrimal system patency. inflammatory debris) and location of obstruc-
Dye normally traverses the nasolacrimal tion, and relieve it.
■
GEOGRAPHY AND SEASONALITY apparatus to exit the nares within 5
• Areas with an abundance of plants minutes (dogs and cats). Acute General Treatment
• Increased incidence in spring and summer ■ Visualization of the dye in the nares • If foreign body is lodged in canaliculi or
can be assisted with a Wood’s lamp (dye lacrimal sac, it may be manually removed
Clinical Presentation fluoresces). by flushing lacrimal punctum.
HISTORY, CHIEF COMPLAINT ■ False-negative results may occur if • If a foreign body is in nasolacrimal duct,
• Ocular discharge (tears, mucoid, purulent, animal licks dye from nares before removal may be accomplished by dacryo-
or a combination) dye is visualized, or dye may drain cystotomy (surgical incision of nasolacrimal
• Owner may report swelling and/or draining caudally into nasopharynx (mainly duct; referable procedure).
tract in skin ventral to medial canthus. brachycephalic breeds). • Advancements in endoscopic technology
Nasolacrimal flushing if complete or partial (lacrimoscopy) have enabled removal of
PHYSICAL EXAM FINDINGS nasolacrimal duct blockage is suspected: foreign bodies from the nasolacrimal duct
Ocular discharge in the form of tears, mucus, • May be done under firm restraint with with minimal invasion; however, this technol-
or pus, with any or all of the following: topical ocular anesthesia (e.g., proparacaine ogy is rarely available.
• Conjunctivitis 0.5%).
• Lacrimal punctal foreign body • Resistant or very small animals or signs of Chronic Treatment
• Swelling and signs of pain in the medial discomfort warrant routine preanesthetic • Care after any of the preceding surgeries
canthal area evaluation and subsequent sedation or general would include topical antibiotic/steroid
• If sufficiently chronic, fistulous tracts may anesthesia. combination medication (neomycin/poly-
be present in the medial canthal area. • Lacrimal puncta can be cannulated. Distal myxin/dexamethasone suspension or oint-
nasal puncta in dogs and cats are too difficult ment q 4-6h) for the first 2-4 postoperative
Etiology and Pathophysiology to identify in many or most individuals weeks.
• Migration of foreign bodies, most frequently irrespective of abnormalities. • Dacryocystotomy requires placement and
plant material, into the nasolacrimal system • Identify dorsal and ventral lacrimal puncta maintenance of a Silastic cannula and oral
• Descending infections from ocular surface (oval in dog and round in cat, with or antibiotics for 3-4 weeks after surgery.
flora, often associated with poor tear drainage without circumferential pigment), 1-2 mm • After lacrimoscopic removal of foreign mate-
and lacrimal stasis, also incriminated with from eyelid margin in palpebral conjunctiva rial, fluoroscopically guided stents are placed,
initiating inflammation near medial canthus. and the patients receive topical antibiotic/

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