Methicillin-resistant Staphylococcus aureus dacryoadenitis.

Abstract

Although classically thought to be primarily a nosocomial infection, the incidence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is rising. In this series we report 3 cases of community-acquired MRSA acute dacryoadenitis in adults presenting within a 3-week period. All cases presented with pain and periocular erythema increasing over approximately 1 week. An S-shaped lid deformity was evident, and 2 of the 3 cases demonstrated multiple pustules/abscesses in the region of the lacrimal gland that were expressing purulent fluid into the superior fornix. Eye cultures yielded MRSA. Each case had complete clinical resolution with 2 to 4 days of intravenous vancomycin followed by 1 week of oral trimethoprim-sulfamethoxazole combination therapy. These cases underscore the changing profile of MRSA infections, especially in the community-based setting. MRSA dacryoadenitis can be difficult to treat with standard therapeutic approaches and may progress to orbital cellulitis. We recommend a short admission for intravenous antibiotic therapy while bacterial sensitivities are being determined before transitioning to a dual-targeted oral antibiotic regimen.