A Rare Case of Bilateral Chronic Dacryocystitis: Due to Punctum Stenosis and Nasolacrimal Duct Obstruction After Onset Thermal Injury
Abstract
Chronic dacryocystitis is inflammation of the lacrimal sac caused by obstruction of the lacrimal drainage system. The condition often causes chronic epiphora, pain, swelling and recurrent infection. Thermal trauma is a rare but significant cause of chronic dacryocystitis, which contributes to fibrosis and progressive obstruction. This case report brings to light a rare presentation of bilateral chronic dacryocystitis due to childhood thermal trauma. A 24-year-old woman presented with complaints of lumps on both lower eyelids with acute exacerbation of pain, swelling and redness in the right eye and epiphora. The patient had a history of facial burns from fireworks sparks when she was 10 years old, which was suspected to cause bilateral punctum stenosis. Clinical examination revealed punctum stenosis and imaging confirmed bilateral chronic dacryocystitis with significant obstruction of the lacrimal drainage. External dacryocystorhinostomy (DCR) procedure with silicone tube insertion was planned as the definitive therapy to restore lacrimal drainage. Chronic dacryocystitis due to thermal trauma is a rare condition involving progressive fibrosis and obstruction of the lacrimal drainage system. Prolonged obstruction increases the risk of recurrent infection and psychosocial consequences due to facial deformity. External DCR, with a success rate of up to 95%, is the main therapeutic option to restore lacrimal drainage function. Bilateral chronic dacryocystitis due to childhood thermal trauma is a rare and complex condition that requires early diagnosis and evidence-based therapy. External DCR is an effective intervention to restore function and improve patients' quality of life.
References
Abazaga, M., & Fechtner, R. (2024). Changes and Diseases of the Aging Eye. In Geriatric Medicine: A Person Centered Evidence Based Approach (pp. 663-689). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-01782-8_58-1
Abbasoglu, O. E., Sener, E. C., & Sanac, A. S. (1996). Factors influencing the successful outcome and response in strabismus surgery. Eye, 10(3), 315–320. https://doi.org/10.1038/eye.1996.66
Ahmed, M. S. (2006). A clinical study of chronic dacryocystitis (Master's thesis, Rajiv Gandhi University of Health Sciences (India)).
Ali, M. J., Xing, G., He, J., Zhao, T., & Gai, J. (2020). Detecting the QTL-allele system controlling seed-flooding tolerance in a nested association mapping population of soybean. The Crop Journal, 8(5), 781–792. https://doi.org/10.1016/j.cj.2020.06.008
Alsuhaibani, A. M. A. F. A. M. (2024, May 7). Canalicular obstruction. In EyeWiki. American Academy of Ophthalmology. Eyewiki. https://eyewiki.org/Canalicular_Obstruction
Badhu, B., Dulal, S., Kumar, S., Thakur, S. K. D., Sood, A., & Das, H. (2005). Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostomy in Nepal. Orbit, 24(2), 79–82. http://dx.doi.org/10.1080/01676830490916073
Badhu, B., Dulal, S., Kumar, S., Thakur, S. K. D., Sood, A., & Das, H. (2005). Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostomy in Nepal. Orbit, 24(2), 79-82. https://doi.org/10.1080/01676830490916073
Barna, S., Garai, I., Kukuts, K., Gesztelyi, R., Toth, L., & Kemeny-Beke, A. (2019). Clinical utility of SPECT/CT and CT-dacryocystography-enhanced dacryoscintigraphy in the imaging of lacrimal drainage system obstruction. Annals of Nuclear Medicine, 33, 746-754. https://doi.org/10.1007/s12149-019-01385-2
Diaz Jr, J. J., Bokhari, F., Mowery, N. T., Acosta, J. A., Block, E. F., Bromberg, W. J., ... & Jerome, R. (2008). Guidelines for management of small bowel obstruction. Journal of Trauma and Acute Care Surgery, 64(6), 1651-1664. https://doi.org/10.1097/ta.0b013e31816f709e
Dolar-Szczasny, J., Barańska, A., & Rejdak, R. (2023). Evaluating the efficacy of teleophthalmology in delivering ophthalmic care to underserved populations: a literature review. Journal of Clinical Medicine, 12(9), 3161. https://doi.org/10.3390/jcm12093161
Eldesoky, S., Farouk, H., Moustafa, A. N., El-noueam, K., & Elsabaa, A. (2012). The role of multi-detector CT dacryocystography in the assessment of naso-lacrimal duct obstruction. The Egyptian Journal of Radiology and Nuclear Medicine, 43(3), 397-405. https://doi.org/10.1016/j.ejrnm.2012.03.006
Harris, H. K., Harper, M., & Kimia, A. (2020). Presentation, diagnostic evaluation, management, and rates of serious bacterial infection in infants with acute dacryocystitis presenting to the emergency department. The Pediatric Infectious Disease Journal, 39(12), 1065-1068. https://doi.org/10.1097/inf.0000000000002848
Kashkouli, M. B., Pakdel, F., & Kiavash, V. (2012). Assessment and management of proximal and incomplete symptomatic obstruction of the lacrimal drainage system. Middle East African Journal of Ophthalmology, 19(1), 60–69. https://doi.org/10.4103/0974-9233.92117
Landani, A., & Himayani, R. (2020). Kelainan Sistem Lakrimal Pada Anak. JIMKI, 8(2), 159-67.
Li, Y., Liu, X., Zhang, W., Song, X., Zhang, L., & Xiao, C. (2022). Differently expressed circular RNAs in lacrimal sacs from patients with chronic dacryocystitis. Frontiers in Genetics, 13, 834111. https://doi.org/10.3389/fgene.2022.834111
Meng, Z., Chen, R., Cao, S., Yu, X., Liu, S., Hu, Y., Li, J., Chen, M., Wang, K., & Liang, X. (2023). Quality of Vision in Eyes with Chronic Dacryocystitis After Endoscopic Dacryocystorhinostomy. Clinical Ophthalmology, 3729–3737. https://doi.org/10.2147/opth.s441094
Pinar-Sueiro, S., Sota, M., Lerchundi, T. X., Gibelalde, A., Berasategui, B., Vilar, B., & Hernandez, J. L. (2012). Dacryocystitis: systematic approach to diagnosis and therapy. Current infectious disease reports, 14, 137-146. https://doi.org/10.1007/s11908-012-0238-8
Qian, Z. B., Yu, B., Yang, Y., Fang, W., Dong, J. L., & Wei, L. Q. (2023). Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography. International Journal of Ophthalmology, 16(8), 1224. https://doi.org/10.18240/ijo.2023.08.06
Rodrigues, A. M., Gonçalves, S. S., de Carvalho, J. A., Borba-Santos, L. P., Rozental, S., & Camargo, Z. P. D. (2022). Current progress on epidemiology, diagnosis, and treatment of sporotrichosis and their future trends. Journal of fungi, 8(8), 776. https://doi.org/10.3390/jof8080776
Scaglione, M., Galluzzo, M., Santucci, D., Trinci, M., Messina, L., Laccetti, E., ... & Beomonte Zobel, B. (2022). Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process. Abdominal radiology, 1-15. https://doi.org/10.1007/s00261-020-02800-3
Schaefer, D. P. (2015). Acquired etiologies of lacrimal system obstructions. The Lacrimal System: Diagnosis, Management, and Surgery, Second Edition, 43-68. https://doi.org/10.1007/978-3-319-10332-7_5
Schaefer, J. L., & Schaefer, D. P. (2020). Acquired causes of lacrimal system obstructions. In Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery (pp. 521-543). Cham: Springer International Publishing. http://dx.doi.org/10.1007/978-3-030-41720-8_33
Schulz, C. B., & Malhotra, R. (2022). The ‘tears’ score: A tool for grading and monitoring epiphora. European Journal of Ophthalmology, 32(4), 2108-2115. https://doi.org/10.1177/11206721221104550
Soebagjo, H. D. (2020). Penyakit sistem lakrimal. Airlangga University Press.
Steele, E. A. (2016). Conjunctivodacryocystorhinostomy with Jones tube: a history and update. Current Opinion in Ophthalmology, 27(5), 439–442. https://doi.org/10.1097/icu.0000000000000287
Sweeney, A., Sweeney, A., Burkat, C. N., Yen, M. T., & Yen, M. T. (2020). Secondary acquired nasolacrimal duct obstruction. San Francisco: American Academy of Ophthalmology, 1–11.
Tschopp, M., Bornstein, M. M., Sendi, P., Jacobs, R., & Goldblum, D. (2014). Dacryocystography using cone beam CT in patients with lacrimal drainage system obstruction. Ophthalmic Plastic & Reconstructive Surgery, 30(6), 486-491. https://doi.org/10.1097/iop.0000000000000154
Copyright (c) 2025 Journal La Medihealtico
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
