Acute Dacryocystitis
Neonates may present with acute dacryocystitis, an inflammation of the lacrimal sac (Fig. 41-4). Pain, tearing, redness, and discharge usually occur. If the child is febrile, culture testing and Gram staining should be done. S. pneumoniae and S. aureus are the most common pathogens. Systemic antibiotics are indicated for the acute stage. The ophthalmologist should be consulted immediately, because irrigation and probing may be necessary to establish drainage as quickly as possible. Severe cases may progress to a dacryocystocele, sepsis, meningitis, or even death, especially in young infants.
Table 41-3 Management of Ophthalmia Neonatorum
|
Disease |
Diagnosis |
Treatment |
|
Gonococcal |
Gram-negative |
Ceftriaxone, 125 mg IM |
|
conjunctivitis |
intracellular diplococci |
single dose plus one of |
|
plus |
the following: | |
|
Growth on chocolate |
Oral tetracycline, | |
|
agar or Thayer-Martin |
500 mg qid | |
|
agar |
Oral doxycycline, | |
|
plus |
100 mg bid | |
|
Fermentation glucose |
Oral erythromycin, | |
|
negative and maltose |
500 mg qid | |
|
negative | ||
|
consultation | ||
|
Other bacterial |
Gram stain |
Gram positive: |
|
conjunctivitis |
plus |
erythromycin ointment |
|
Growth on blood agar |
qid, or fluoroquinolone | |
|
or chocolate agar |
qid, for 2 wk | |
|
Gram negative: | ||
|
gentamicin, tobramycin, | ||
|
or fluoroquinolone, qid | ||
|
for 2 wk | ||
|
Giemsa stain— |
Tetracycline, 500 mg qid | |
|
conjunctivitis |
basophilic |
for 3-4 wk |
|
intracytoplasmic |
Erythromycin, 250-500 mg | |
|
inclusion bodies |
for 3 wk | |
|
plus |
Doxycycline, 100 mg bid | |
|
Chlamydial culture |
for 2 wk | |
|
Azithromycin, 1 g | ||
|
(one dose) |
IM, Intramuscularly; bid, twice daily; qid, four times daily.
IM, Intramuscularly; bid, twice daily; qid, four times daily.
- Figure 41-3 Purulent conjunctivitis may indicate infection with Staphylococcus, Haemophilus influenzae, Streptococcus, or Pseudomonas. (From American Academy of Ophthalmology. The Red Eye. San Francisco, AAO Professional Information Committee, 1986 [AAO. The Red Eye].)
Figure 41-4 Acute dacryocystitis in a neonate with fever and malaise. Lacrimal sac massage and systemic antibiotics relieved the acute infection.
Figure 41-5 Congenital glaucoma in a 2-month-old infant who presented with a cloudy cornea involving the right eye. Intraocular pressure was elevated. The diagnosis was congenital glaucoma.
Figure 41-4 Acute dacryocystitis in a neonate with fever and malaise. Lacrimal sac massage and systemic antibiotics relieved the acute infection.
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