Ethmoiditis Mimicking Acute Dacryocystitis-An Underreported Pathology

To review the mechanism, differential diagnosis, and management of ethmoiditis mimicking acute dacryocystitis (EMAD) through a case series and prior reports.

A systematic review of the literature was performed on PubMed, Medline, and Google Scholar to capture all well-documented cases of EMAD.

The current series includes 5 patients with EMAD documented by a single oculofacial plastic surgeon over 24 months. When adding 6 previously published cases, 11 patients with EMAD have been reported. In all cases, EMAD was considered an anterior ethmoid sinus infection extending into the orbit, adjacent to the lacrimal sac. However, on both computed tomography imaging and external examination, EMAD mimicked an abscess within the confines of the lacrimal sac, yielding an initial misdiagnosis of acute dacryocystitis. Ethmoiditis mimicking acute dacryocystitis was distinguished by free lacrimal irrigation in 100% of patients and frank ipsilateral anterior ethmoid sinusitis in 73%. Furthermore, dacryocystography and endoscopy have confirmed that the infectious mass lies medial to the lacrimal sac. Medical management included systemic antibiotics (100%), nasal decongestants (45%), and systemic glucocorticoids (9%). Recurrence after medical management occurred in 55%, who all subsequently underwent curative anterior ethmoidectomy.

Ethmoiditis mimicking acute dacryocystitis is an anterior ethmoid air cell infection that extends into the orbit, adjacent to the lacrimal sac. Ethmoiditis mimicking acute dacryocystitis is underreported-as evidenced by a consistent misdiagnosis of acute dacryocystitis, as well as the current series identifying 5 cases over just 24 months. Greater awareness of EMAD is important, as its management differs significantly from that of dacryocystitis.