Delhi Journal of Ophthalmology

Preseptal Cellulitis as a Presenting Feature of Bilateral Acute Suppurative Bacterial Dacryoadenitis

Sumit Grover, NP Singh
Department Of Ophthalmology, Dr. Baba Saheb Ambedkar Hospital, Rohini, Delhi, India

Corresponding Author:

Sumit Grover
(Sec) Resident, Department Of Ophthalmology,
Dr. Baba Saheb Ambedkar Hospital, Rohini, Delhi, India.
Email:dr.sumitgrover@gmail.com

Received: 01-OCT-2015

Accepted: 28-DEC-2016

Published Online: 09-MAR-2016

DOI:http://dx.doi.org/10.7869/djo.193

Abstract

Keywords :

Dear editor,

Acute suppurative bacterial dacryoadenitis involves inflammation of the lacrimal gland and is a rare condition.[1] The presence of preseptal swelling can mask the typical eyelid findings of dacryoadenitis. This case highlights the need for imaging for early diagnosis of dacryoadenitis in cases of red swollen eyes not responding to oral antibiotics.

Case Report

A 7 year-old male presented to our OPD with complaints of pain, swelling and irritation, in both eyes for two days. (Figure 1a)





Examination of both eyes revealed a visual acuity of 6/6, edema and erythema of lids, normally reacting pupils, extraocular muscle movements full and free. Patient was empirically started on oral amoxicillin-clavulanic acid, however, the condition worsened with increased conjunctival congestion and chemosis. Swelling and erythema of lids increased with development of limitation of extra ocular movements in all directions. Blood counts revealed leucocytosis. CT scan of the orbits showed a hypodense area within enlarged lacrimal glands suggestive of localized lacrimal abscess. Diagnosis of ASBD (acute suppurative bacterial dacryoadenitis) was established. Patient was administered ceftazidime and amikacin intravenously and the condition improved within a day and completely recovered by 7th day.

ASBD is a rare entity and may be acute, subacute, or chronic. Patients generally present with redness, tenderness, warmth, and swelling of the lateral third of the upper eyelid.[2] CT scan is a useful tool to determine the involvement of the orbital tissues.[3] Inapproprite treatment can result in lacrimal gland or orbital abscess, orbital cellulitis and lid ptosis. Patients should be followed up closely and IV antibiotics should be administered if worsening is noted to avert development of sight threatening complications.

References
  1. Chandravanshi SL, Mishra V. Acute suppurative bacterial dacryoadenitis :a rare case report. Eur J Ophthalmol 2014; 24:790-2.
  2. Rai P, Shah SA, Kirshan H. Acute Dacryadenitis-analysis of 23 cases. MedChannel 2009;15:71-6.
  3. Voyatzis G, Chandrasekharan L, Francis I,Malhotra R. The Importance of Clinicians Reviewing CT Scans in Suspected Lacrimal Gland Disease Causing Eyelid Swelling, Even if Radiologists Previously Interpreted them as Normal. Open Ophthalmol J 2009; 3:26–8.

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Grover S, Singh NPPreseptal Cellulitis as a Presenting Feature of Bilateral Acute Suppurative Bacterial Dacryoadenitis.DJO 2016;26:302

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Grover S, Singh NPPreseptal Cellulitis as a Presenting Feature of Bilateral Acute Suppurative Bacterial Dacryoadenitis.DJO [serial online] 2016[cited 2019 Dec 6];26:302. Available from: http://www.djo.org.in/articles/26/4/preseptal-cellulitis.html