A major review of viral lacrimal drainage infections

We present a review of viral lacrimal drainage infections.

A literature review was conducted using Medline and Embase databases following PRISMA guidelines. Twenty-seven studies met the inclusion criteria and were synthesised narratively. Data obtained include demographics, clinical presentation, types of viral infection, location of the infection, investigations, medical and surgical treatment, symptom resolution, complications, and infection sequelae.

Four hundred and fifty-five cases of viral lacrimal drainage infections have been reported so far.  The majority of viral lacrimal drainage infections were secondary to herpes simplex virus (HSV) (83.1%, 378/455), followed by adenovirus (11.9%,54/455), varicella zoster virus (VZV) (2.2%, 10/455), and Epstein-Barr virus (EBV) (2.0%, 9/455). The majority [47.5% (216/455)] involved the canaliculus only. Of the 16 patients with nasolacrimal ductobstruction, all cases were related to adenovirus, EBV or VZV infections, not HSV. Where specified, 100% (10/10) cases of EBV-related lacrimal drainage infections and 75% (3/4) VZV-related lacrimal drainage infections completely resolved following conservative treatment alone. In contrast, only 1.1% (2/186) cases of HSV-related lacrimal drainage infection, and 5% (1/20) of adenovirallacrimal drainage infections, improved following conservative treatment alone.

Viral lacrimal drainage infections are relatively uncommon but should be suspected in patients presenting with new onset epiphora in the context of recent viral infections. Of these, the majority are likely to be related to HSV followed by adenovirus, which seem to be associated with a higher risk of permanent epiphora from scarring, compared with VZV and EBV infections, where the symptoms may be more likely to resolve through conservative treatment alone.