Overview

Dacryocystitis is an infection or inflammation of the lacrimal sac, a part of the tear drainage system located near the inner corner of the eye. This condition typically occurs when the nasolacrimal duct, which drains tears from the eye into the nose, becomes blocked, leading to the accumulation of fluid and subsequent bacterial growth. Dacryocystitis can be acute or chronic, with acute cases presenting suddenly and severely, while chronic cases involve persistent mild symptoms. The condition can affect individuals of all ages but is more common in infants and older adults, particularly women. Prompt treatment is crucial to prevent complications such as abscess formation or the spread of infection to surrounding tissues.

Causes

Dacryocystitis primarily occurs due to obstruction of the nasolacrimal duct, leading to stagnant fluid that promotes bacterial growth. Common causes include:

• Congenital blockage: In infants, a membrane at the end of the tear duct may fail to open at birth, causing congenital dacryocystitis.
• Infection: Bacterial infections, often caused by Staphylococcus aureus, Streptococcus species, or Haemophilus influenzae, are the leading causes of dacryocystitis.
• Age-related narrowing: In adults, age-related changes can narrow the tear duct and lead to blockage.
• Chronic sinusitis: Recurrent or chronic sinus infections can contribute to blockage and infection of the tear duct system.
• Nasal or facial trauma: Injuries or fractures involving the nose or facial bones can damage the nasolacrimal duct, resulting in blockage.
• Inflammatory diseases: Conditions like sarcoidosis or Wegener’s granulomatosis can cause secondary obstruction of the tear duct.
• Nasal or sinus tumors: Rarely, masses or tumors in the nasal cavity can compress or block the nasolacrimal duct.

Symptoms

The symptoms of dacryocystitis vary depending on whether the condition is acute or chronic:

• Acute dacryocystitis:
  • Sudden onset of pain, redness, and swelling near the inner corner of the eye.
  • Tenderness and warmth over the lacrimal sac.
  • Excessive tearing (epiphora).
  • Discharge of pus or mucus from the eye, especially when pressing on the area.
  • Fever and general malaise in severe cases.
• Chronic dacryocystitis:
  • Persistent tearing or watery eyes.
  • Mild swelling near the inner eye corner without significant redness or pain.
  • Occasional mucous discharge.
  • Recurring infections or episodes of acute inflammation.

Diagnosis

Diagnosing dacryocystitis involves clinical examination and, in some cases, additional tests to confirm tear duct blockage and identify the causative organism:

• Physical examination: A healthcare provider assesses the affected eye for redness, swelling, tenderness, and discharge.
• Lacrimal sac pressure test: Gentle pressure over the lacrimal sac may express pus or mucus through the puncta, confirming blockage and infection.
• Cultures: Discharge may be collected and cultured to identify the specific bacteria causing the infection and guide antibiotic therapy.
• Dye disappearance test: Fluorescein dye is placed in the eye, and its clearance is monitored to assess the patency of the tear drainage system.
• Imaging studies: In chronic or recurrent cases, dacryocystography or CT scans may be used to evaluate the nasolacrimal system for obstructions or anatomical abnormalities.

Treatment

Treatment of dacryocystitis aims to resolve the infection, relieve symptoms, and address the underlying cause of tear duct blockage:

• Antibiotics: Oral antibiotics are prescribed for acute dacryocystitis to control infection. Severe cases may require intravenous antibiotics.
• Warm compresses: Applying warm compresses to the affected area several times a day helps reduce swelling and promote drainage.
• Pain management: Over-the-counter pain relievers such as acetaminophen or ibuprofen can alleviate discomfort.
• Surgical intervention:
  • Dacryocystorhinostomy (DCR): A common surgical procedure for adults, creating a new passage for tears to drain into the nasal cavity, bypassing the blockage.
  • Probing: In infants, a simple probing procedure under anesthesia often resolves congenital dacryocystitis.
  • Abscess drainage: If an abscess forms, it may need to be surgically drained.
• Treating underlying causes: Managing sinus infections, removing nasal polyps, or addressing systemic diseases may be necessary to prevent recurrence.

Prognosis

The prognosis for dacryocystitis is generally excellent with prompt and appropriate treatment. Acute dacryocystitis usually resolves completely with antibiotics and supportive care, although surgery may be required to prevent recurrence. In infants, probing has a high success rate, and most cases are resolved by the age of one year.

Chronic dacryocystitis may require surgical correction to achieve long-term relief, but outcomes after procedures like dacryocystorhinostomy are very favorable. Untreated dacryocystitis can lead to complications such as abscess formation, cellulitis, or in rare cases, orbital cellulitis, making early medical intervention crucial. With timely care, most patients recover fully and maintain normal tear drainage function.