Section on ophthalmology. (Abstracts of Scientific Posters).

OPHl-C. SPONTANEOUS PASSAGE OF DACRYOLITH. Bradley J. Luttrell, MD, and Steven R. Anderson, MD. Chattanooga, TN.

This case report describes a 38-year-old white man with a 2-day history of dacryocystitis that resolved after spontaneous passage of a large dacryolith. Acute dacryocystitis is commonly associated with a nasolacrimal duct obstruction, either as a causative agent or as a result of stasis in the nasolacrimal duct. Often, acute dacryocystitis presents with erythema and swelling below the medial canthal tendon due to painful distension of the lacrimal sac. Complications of untreated or inadequately treated dacryocystitis can be severe, with mucocele formation, chronic conjunctivitis, and even orbital cellulitis occurring. Initial treatment consists of warm compresses and oral antibiotics. The antibiotics should provide broad coverage, as gram-positive bacteria are the most common cause of acute dacryocystitis, but gramnegative organisms can be the causative agent in certain cases. It is uncommon for the patient to spontaneously pass a dacryolith, and even more uncommon for this to be recovered, as patients will p ass the stone into the nasopharynx without discovery and swallow the stone. This case is unusual in that we were able to recover the stone, and after passage of this dacryolith the patient had rapid resolution of his dacryocystitis. Acute dacryocystitis often will progress to chronic and recurrent dacryocystitis and require surgery, usually a dacryocystorhinostomy, and if there is a stone present it can occasionally be recovered at surgery.