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Ethmoiditis Mimicking Acute Dacryocystitis-An Underreported Pathology.

Steffie Arès1, Philippe Lavigne2, Evan Kalin-Hajdu1

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Ethmoiditis mimicking acute dacryocystitis (EMAD) is an orbital infection often misdiagnosed as dacryocystitis. Early recognition and specific management, often requiring ethmoidectomy, are crucial for effective treatment and preventing recurrence.

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Area of Science:

  • Ophthalmology
  • Otorhinolaryngology
  • Infectious Diseases

Background:

  • Ethmoiditis mimicking acute dacryocystitis (EMAD) presents as an anterior ethmoid sinus infection extending into the orbit.
  • This condition is frequently misdiagnosed as acute dacryocystitis due to similar clinical presentations on imaging and examination.
  • Underreporting of EMAD is suggested by the identification of 5 cases within a 24-month period.

Purpose of the Study:

  • To review the mechanism, differential diagnosis, and management of ethmoiditis mimicking acute dacryocystitis (EMAD).
  • To highlight the importance of distinguishing EMAD from acute dacryocystitis for appropriate patient care.

Main Methods:

  • A systematic literature review was conducted using PubMed, Medline, and Google Scholar.
  • The review aimed to identify and analyze all documented cases of EMAD.

Main Results:

  • Eleven cases of EMAD were analyzed, including 5 from the current series.
  • EMAD was consistently identified as an anterior ethmoid infection adjacent to the lacrimal sac, often mistaken for lacrimal sac abscess.
  • Key distinguishing features included free lacrimal irrigation (100%) and evidence of sinusitis (73%).
  • Dacryocystography and endoscopy confirmed the infectious mass location medial to the lacrimal sac.
  • Medical management (antibiotics, decongestants, glucocorticoids) led to recurrence in 55% of patients, necessitating anterior ethmoidectomy.

Conclusions:

  • Ethmoiditis mimicking acute dacryocystitis is an underrecognized entity requiring greater clinical awareness.
  • Accurate diagnosis is critical as management strategies differ significantly from acute dacryocystitis.
  • Prompt identification and appropriate intervention, potentially including surgery, are essential for successful outcomes.