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

Ophthalmology

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

Chlamydial

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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