Author’s Disclosure Block: Steffie Arès, none; Evan Kalin-Hajdu, none

Abstract Body
Purpose:To review the causative mechanisms, diagnostic findings, and management of a new series of patients with pseudodacryocystitis, as well as those who have been previously reported. Study Design: Systematic review of the literature Methods: A systematic review was performed of Pubmed, Medline, and Google Scholar to capture all well-documented cases of pseudodacryocystitis. Results: The current series had 4 cases of pseudodacryocystitis referred to the senior author over 24 months. Including the current series, 10 cases of pseudodacryocystitis have been described. Nine patients were female and 1 male, with a median age of 7.5 years (range 7 months to 56 years). Nine patients were initially misdiagnosed with acute dacryocystitis. Infection of anterior ethmoid air cells propagating into the lacrimal sac fossa was present in 7 cases, whereas 3 cases occurred without evidence of sinusitis. A clinical and radiological mass effect within the lacrimal sac fossa was present in every case and all patients had a patent nasolacrimal duct. Medical management included systemic antibiotics (100%), nasal decongestants (40%), and systemic glucocorticoids (10%). Recurrences after medical management occurred in 5 patients who all eventually underwent curative anterior ethmoidectomy. When specified (7 cases), follow-up after resolution was a median of 11 months. Conclusion: Despite no relation to the lacrimal sac or nasolacrimal duct obstruction, pseudodacryocystitis is usually misdiagnosed as acute dacryocystitis. Given that pseudodacryocystitis is caused by infection of the anterior ethmoid sinus, it is likely that surgeons are often unknowingly curing patients with dacryocystorhinostomy surgery – further suppressing the reporting of cases. Appropriate treatment for pseudodacryocystitis includes the medical management of infectious sinusitis and, when recurrent, anterior ethmoidectomy.