21 terms

Dacryocystitis

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Overview
Infection of the lacrimal sac resulting from obstruction of the nasolacrimal duct
Congenital or acquired (acute or chronic)
Overview-Pathophysiology
The lacrimal excretory system is a mucous membrane-lined tract that's contiguous with the conjunctival and nasal mucosa.
The conjunctival and nasal mucosa are normally colonized with bacteria.
Inability to drain tears due to a blocked lacrimal drainage system results in infection. (See A close look at tears.)
The congenital form is related to incomplete canal formation of the nasolacrimal duct.
Overview-Causes
Beta-hemolytic streptococci
Nasal disease
Staphylococcus aureus
Haemophilus influenza
Methicillin-resistant S. aureus
Overview-Acute Form
Beta-hemolytic streptococci
Nasal disease
Staphylococcus aureus
Haemophilus influenza
Methicillin-resistant S. aureus
Overview-Chronic Form
Chronic mucosal degeneration
Fungi, such as Actinomyces or Candida albicans
Streptococcus pneumoniae
Overview-Incidence
Dacryocystitis is most common in adults older than age 40.
This disease occurs more commonly on the left side than on the right side.
It occurs rarely in Blacks.
Dacryocystitis affects females more commonly than males.
Overview-Complications
Hemorrhage
Infection
Orbital cellulitis
Cerebrospinal fluid leakage
Assessment-History
Eye pain
Fever
Assessment-Physical Findings
Severe erythematous swelling around the nasal aspect of the lower eyelid
Tenderness of the eyelid
Tearing (more common with chronic form)
Conjunctival injection
Palpable mass inferior to the medial canthal tendon
Decreased visual acuity
Orbital cellulitis
Periorbital edema
Diagnostic Test Results-Laboratory
Culture of discharge demonstrates organism.
White blood cell count is elevated.
Diagnostic Test Results-Imaging
X-rays after injection of a radiopaque medium locate atresia or skeletal facial anomalies.
Dacryocystography and dacryoscintigraphy identify anatomical abnormalities of the nasolacrimal drainage system.
Treatment-General
Warm compresses
Lacrimal sac massage
Treatment-Activity
As tolerated
Treatment-Medications
Eyedrops, such as trimethoprim sulfate and polymyxin B sulfate, gentamicin sulfate, levofloxacin, or tobramycin; corticosteroid eyedrops for chronic dacryocystitis due to allergic rhinitis
Antibiotics, such as oral amoxicillin and clavulanate or I.V. ampicillin and sulbactam, levofloxacin (for acute dacryocystitis with orbital cellulitis)
Intranasal saline (postoperatively) to keep surgical area clean and open
Treatment-Surgery
Incision and drainage
Dacryocystorhinostomy
Nursing Considerations-Nursing Diagnoses
Acute pain
Anxiety
Impaired tissue integrity
Ineffective health maintenance
Risk for infection
Nursing Considerations-Expected Outcomes
express feelings of increased comfort
express feelings of decreased anxiety
have reduced swelling, redness, and pain
maintain current health status
remain free from signs and symptoms of infection.
Nursing Considerations-Nursing Interventions
Assist with obtaining a culture of the site to determine the underlying cause.
Give prescribed antibiotics. If I.V. antibiotics are prescribed, ensure patent I.V. access.
Apply warm compresses to the area as ordered.
Provide meticulous eye hygiene measures.
Institute appropriate infection control precautions based on the underlying infectious organism; ensure meticulous handwashing. Adhere to standard precautions.
Assist with lacrimal massage as indicated.
Prepare the patient and family for possible surgery.
Nursing Considerations-Monitoring
Eye pain
Swelling
Signs and symptoms of infection
Postoperative vital signs
Surgical site
Signs and symptoms of bleeding
Nursing Considerations-Associated Nursing Procedures
Blood pressure assessment
Eye care
Eye compress application, warm
Eyedrop administration
IV bag preparation
IV bolus injection
IV catheter insertion
Oral drug administration
Pain management
Postoperative care
Preoperative care
Preparing a patient for ophthalmic surgery, OR
Pulse assessment
Respiration assessment
Patient Teaching-General
disorder, diagnosis, underlying cause, and treatment, including I.V. antibiotics for acute dacryocystitis with orbital cellulitis and appropriate eyedrops
prescribed medications, including antibiotics and ophthalmic drops
possible adverse reactions to prescribed medications
correct technique for instilling eyedrops
eye hygiene care measures
application of warm compresses
signs and symptoms of worsening infection
signs and symptoms of possible postoperative complications, including bleeding and infection, and the need to report them to a practitioner immediately
use of intranasal saline spray postoperatively.