A Potentially Devastating Lid Infection

The lid is a very complex, and important structure. It has multiple functions that require a constant flow of fluids, and physiological maintenance. Disruption of any part of this mechanism can, and often does result in disease, pain and the possibility of secondary complications. The lid’s most basic function is to protect the eye from trauma. This is accomplished by simply closing the eye. The lashes also play a role as they catch debris, and inform us when something is too close to our eyes. In addition, they house many glands that secrete fluids that bathe our eyes and keep them moist.

If any of the glands of the lid get clogged, infection results, and often called a stye. It present as a red bump in the lid, that is tender to the touch. The lid is red and swollen, and may even appear as a pimple on the lid if the infection is in the front section of the lid. Another lid infection, blepharitis, is an inflammation of the lid, and appears as a red lid margin with debris on the lid surface. It often leads to dry, red eyes, and general discomfort of the eye. Proper treatment will alleviate this condition.

A more serious condition of the lid area is Dacryocystitis which is an infection of the nasolacrimal sac. This lies between the inner corner of the eye lid and the nose. It most often results from blockage of the duct that permits tears to flow from the tear producing gland to the nose. This condition most often causes pain, redness and swelling of the inner most area of the lid, and excessive tearing. The blocked tear duct becomes infected with bacteria such as Staphylococcus aureus, Streptococcus pneumoriae and Pseudomonas. Dacryocystitis may be acute or chronic and may be the result of tear duct malformation, injury, trauma and infection.

Clinical presentations will include the pain, redness and swelling as well as puss that will extrude with digital pressure to the area. Most patients are very uncomfortable and present with a puffy red inner eye lid. It looks different then a basic lid infection in that the location, and is always nasal and the pain is much more severe with palpation, or digital pressure.

According to Dr. Marc Werner, an Oculoplastic surgeon from Long Island, NY, aggressive treatment is necessary to prevent secondary complications. He recommends irrigating the infected duct to clear any obstructions, and clear away bacteria infected puss. If the irrigation is not effective in opening a clean duct, then surgery is required to cure this condition. In addition, oral antibiotics, and topical antibiotics and on occasion a topical steroid is employed to reduce the inflammation. Palpitating the effected area to remove as much of the puss as possible is necessary at the onset of treatment. Proper follow up is also required on a daily basis to make sure that the infection is draining and not spreading to the surrounding ocular areas. Dr. Werner always checks vision and pupillary function on every visit for the same reason. It should be noted that Dr. Werner is also a Neuro-Ophthalmologist and as such always looks for any potential neurological complication that might arise.

If the Dacryocystitis does not resolve with this therapy, and the duct remains obstructed then when the initial infection is eliminated a surgical procedure called Dacryocystorhinostomy ( DCR) must be performed. This is done under general anesthesia and creates a new passage for the tears to flow. As usual, proper diagnosis and treatment is required from the start to obtain the best possible outcome.