Dacryocystitis caused by community-onset methicillin-resistant Staphylococcus aureus

Purpose: To describe the occurrence of community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections of the lacrimal system and their treatment. Methods: This cases series consisted of data obtained from seven clinical cases of acute or subacute MRSA dacryocystitis, with or without concurrent conjunctivitis, occurring in nonhospitalized individuals presenting between December 2001 and July 2003. Clinical presentations, microbial culture results, treatment modalities, and outcomes were retrospectively reviewed. Results: Three patients were successfully treated with antibiotics and lacrimal surgery with no recurrence of symptoms after surgery for 6 months or longer. Four patients had temporary relief of symptoms with antibiotic therapy, but surgery was not performed for nonophthalmologic reasons, and recurrence occurred. Conclusions: The treatment of MRSA dacryocystitis can be challenging. Microbiologic cultures should be performed in all patients with dacryocystitis that is unresponsive to conventional first-line antibiotic treatment and in patients at risk for acquisition of MRSA. Appropriate antibiotic therapy in combination with dacryocystorhinostomy appears to be the optimal treatment.