Acute dacryocystitis retention: a case report and literature review

Abstract

Acute dacryocystitis retention (ADR) is an unusual entity that contributes to an incorrect diagnosis and treatment. We describe a case of acute dacryocystitis retention occurring in a 61-year-old diabetic male who presented with severe pain, swelling, and inflammatory signs above the left medial canthal ligament tendon. He had no previous history of epiphora. Computed tomography scan indicated acute dacryocystitis. Clinical treatment resulted in complete resolution of the condition. Syringing one month after the acute episode indicated a patent lacrimal excretory system. The temporary obstruction that evolved to an acute dacryocystitis retention was probably secondary to nasal alteration or supposed dacryoliths. Timely, conservative clinical treatment can lead to complete resolution of acute dacryocystitis retention with no further treatments.

Figure 1

(A) Clinical photo showing left inner canthus swelling with inflammatory signs located above the medial canthal ligament tendon. (B-C) Axial post-contrast CT scan images revealed a well-defined, ovoid-shaped marginally enhanced lesion of near-fluid density noted anteriorly to the orbital septum and above the left medial canthus (black arrow). (D) Coronal and (E) sagittal reconstruction from the CT scan image showing a mucous fluid-filled normal-sized nasolacrimal sac (white arrow) with a normal diameter of the intraosseous funnel-shaped nasolacrimal ductus extending from the lacrimal sac and ending in the inferior nasal meatus, below the inferior turbinate (long white arrow). Hypertrophic inferior nasal turbinate and deviated bony nasal septum toward the affected side. No differences were observed between the right or left nasolacrimal sac or nasolacrimal duct width, length, or angulation slope. No evidence of deep orbital inflammation.