Pseudodacryocystitis arising from anterior ethmoiditis

The contiguous spread of inflammation from infected ethmoid sinuses to the surrounding tissues of the lacrimal drainage system can produce symptoms easily confused with acute dacryocystitis. We report the cases of two patients with presumed dacryocystitis whose patency of the lacrimal apparatus was established by probing, irrigation, and dacryocystography. Computerized tomography and magnetic resonance imaging demonstrated opacification of anterior ethmoid air cells adjacent to the region of the lacrimal sac. A greater awareness of this diagnostic possibility of pseudodacryocystitis arising from anterior ethmoiditis, together with improved noninvasive imaging techniques, will likely increase the observed incidence of this disease. This distinction is important since anterior ethmoidectomy, rather than dacryocystorhinostomy, is the treatment of choice when such pseudodacryocystitis proves unresponsive to antibiotic therapy. In misdiagnosed patients who undergo dacryocystorhinostomy, it is the coincidental limited anterior ethmoidectomy and not the lacrimal-nasal fistula that provides the cure.