EpistemisPainful swelling of the inner canthus
Specialty: Ophthalmology.
Why it occurs
- Acute dacryocystitis (acute bacterial infection of the lacrimal sac, commonly secondary to chronic obstruction of the nasolacrimal duct)
- Acute or chronic bacterial canaliculitis (common due to Actinomyces israelii with the presence of concretions in the canaliculi)
- Infected congenital or acquired dacryocystocele
- Dermoid or epidermoid cyst complicated with superinfection
- Nasal root soft tissue abscess
Initial workup
Physical eyelid and canthal examination assessing the sign of fluctuation; Gentle expression of the puncta in search of mucopurulent reflux (avoid vigorous expression in phases of extreme acute pain to prevent rupture of the lacrimal sac); Culture of the purulent material obtained and Gram stain; Computed Tomography (CT) of the orbits if there is suspicion of spread of the infection to the retroseptal space or associated bone involvement.
red flags
Erythematous and extremely painful swelling located under the medial canthal tendon that progresses with diffuse erythema towards the upper and lower eyelids, marked local heat, fever, painful limitation of eye movements and diplopia, indicative of orbital cellulitis secondary to dacryocystitis, requiring drainage and surgical admission.
Standard management
- Amoxicillin with Clavulanic Acid — 875/125 mg orally every 8 hours for 10-14 days as first-line empirical broad-spectrum systemic antibiotic therapy in adult dacryocystitis
- Tobramycin — 0.3% eye drops, 1 drop every 4-6 hours to protect the conjunctiva from purulent reflux
- Paracetamol (500-1000 mg orally every 8 hours, alternating with ibuprofen 400 mg if necessary for systemic analgesic and anti-inflammatory control).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Ophthalmology
- Listed causes
- 5
- Treatment options
- 3