Orbital abscess secondary to acute dacryocystitis.

Purpose: To provide Australian data and a literature review on the clinical, radiological, and microbiological features and outcomes in patients with orbital abscess secondary to dacryocystitis.

Methods: Multicentre retrospective review of orbital abscess secondary to acute dacryocystitis from 2019 to 2024 in Australia.

Results: Eight cases were identified. The median age was 56 years (range, 26-80 years) with no gender predilection. Common presenting symptoms and signs were motility restriction (n  = 6, 75%), proptosis (n = 5, 62.5%), decreased visual acuity (n = 4, 50%), chemosis (n  = 3, 37.5%) and RAPD (n = 2, 25%). Radiologically inferomedial (n  = 3, 37.5%) and medial (n  = 2, 25%) orbital involvement was most commonly followed by intraconal (n = 2, 25%) and inferior (n = 1, 12.5%) orbit. Microbiological cultures revealed gram-negative bacteria (n = 3), gram-positive bacteria (n  = 1), anaerobic growth (n = 1), polymicrobial growth (n  = 1), MRSA (n = 1), and no growth (n = 1). Treatment included intravenous antibiotics in all cases, 4 patients underwent orbital abscess drainage combined with DCR, 1 had orbital drainage alone, 1 had endoscopic DCR alone, 1 had canthotomy with cantholysis, and 1 patient did not receive surgical treatment. One patient lost vision (light perception) with remainder having stable or improved visual acuity at follow up.

Conclusion: Acute surgical management needs to be considered in majority of cases with dacryocystitis and orbital abscess. Signs of orbital involvement in acute dacryocystitis should be identified promptly to prevent irreversible visual loss.