Osteopoikilosis and dacryocystitis
Overview
A rare syndrome characterized by dactyocystitis (tear duct infection) and osteopoikilosis (hardened areas on ends of bones).
Symptoms
* Narrowed tear duct * Tear duct inflammation * Bone development abnormality
Causes
Atresia of the nasolacrimal ducts results from failure of canalization or, in the first few months of life, from blockage when the membrane that separates the lower part of the nasolacrimal duct and the inferior nasal meatus fails to open spontaneously before tear secretion. Bony obstruction of the duct may also occur. In acute dacryocystitis, Staphylococcus aureus and, occasionally, beta-hemolytic streptococci are the cause. In chronic dacryocystitis, Streptococcus pneumoniae or, sometimes, a fungus — such as Actinomyces or Candida albicans — is the causative organism. Primary lumps and secondary tumors from sinuses, nose, and orbits have also been reported as causes.
Diagnosis
Clinical features and a physical examination suggest dacryocystitis. Culture of the discharged material demonstrates Staphylococcus aureus and, occasionally, beta- hemolytic streptococci in acute dacryocystitis, and Streptococcus pneumoniae or C. albicans in the chronic form. The white blood cell count may be elevated in the acute form; in the chronic form, it’s generally normal. An X-ray after injection of a radiopaque medium (dacryocystography) locates the atresia in infants.
Treatment
Treatment for acute dacryocystitis consists of warm compresses, topical and systemic antibiotic therapy and, occasionally, incision and drainage. Chronic dacryocystitis may eventually require dacryocystorhinostomy. Laser-assisted endoscopic dacryocystorhinostomy and balloon dilatation or probing of the nasolacrimal system may also be used. Therapy for nasolacrimal duct obstruction in an infant consists of careful massage of the area over the lacrimal sac four times a day for 6 to 9 months. If this fails to open the duct, dilation of the punctum and probing of the duct are necessary.