Orbital Cellulitis Secondary to Dacryocystitis: A Case Series and Literature Review

This study aimed to determine risk factors, and describe management and outcomes in patients who developed orbital cellulitis secondary to dacryocystitis.

Multicenter retrospective case series with 18 patients and review of published cases.

The mean age was 62 years, 56% were female and 50% had recurrent dacryocystitis. Visual acuity was reduced in the affected eye with a mean of 0.27 logMAR (Snellen 20/40) which improved to 0.15 logMAR (Snellen 20/30) at final follow up. Two cases (12%) had dacryoliths and 1 patient had sarcoidosis within the lacrimal sac. Gram-positive bacteria were identified in 73% (11/15), gram-negative bacteria in 13% (2/15), and mixed infection in 13% (2/15), respectively. Cases who had dacryocystorhinostomy as definitive treatment, either acutely (n = 3) or electively (n = 10) had full resolution. Transcutaneous drainage of the medial wall abscess in 10 patients helped resolve acute cellulitis. Four patients declined dacryocystorhinostomy after transcutaneous drainage; 2 had repeated dacryocystitis and orbital cellulitis, while 2 had no further infective episodes. One immunosuppressed patient had rapid progression to non-perception-of-light vision due to fungal invasion. Forty-six published cases reported up to 28% permanent loss of vision (perception-of-light and non-perception-of-light). Dacryoliths were discovered in 17% of published cases.

Orbital cellulitis complicating dacryocystitis appears to be related to recurrent dacryocystitis and possibly the presence of dacryoliths. Immunosuppression is identified as a poor prognostic factor in this series. While transcutaneous drainage works well as a temporizing measure, dacryocystorhinostomy either done acutely or deferred until resolution of orbital cellulitis is required for definitive cure.