Dacryocystitis

Dacryocystitis is an inflammation of the tear sac (lacrimal sac) at the inner corner of the eye.

Description

Tears drain into little openings (puncta) in the inner corners of the eyelids. From there, the tears travel through little tube-like structures (canaliculi) to the lacrimal sac. The nasolacrimal ducts then take the tears from the lacrimal sac to the nose. That's why people need to blow their nose when they cry a lot.

Dacryocystitis is usually caused by a blockage of the nasolacrimal duct, which allows fluid to drain into the nasal passages. When the lacrimal sac does not drain, bacteria can grow in the trapped fluid. This condition is most common in infants and people over 40 years old.

Causes and symptoms

In newborn infants, the nasolacrimal duct may fail to form an opening—a condition called dacryostenosis. The cause of dacryocystitis in adults is usually associated with inflammation and infection in the nasal region. Dacryocystitis can be acute, having a sudden onset, or it can be chronic, with symptoms occurring over the course of weeks or months. Symptoms of acute dacryocystitis can include pain, redness, tearing, and swelling at the inner corner of the eye by the nose. In chronic dacryocystitis, the eye area may be swollen, watery or teary, and, when pressure is applied to the area, there may be a discharge of pus or mucus through the punctum.

Dacryocystitis of the right eye. The inner corner of the lower lid is bulging from an inflamed tear sac. Blockage of the tear duct causes fluid to be trapped in the tear sac, which becomes infected. (Custom Medical Stock Photo. Reproduced by permission.)

Diagnosis

Dacryocystitis usually occurs in only one eye. As mentioned, the symptoms can range from watery eyes, pain, swelling, and redness to a discharge of pus when pressure is applied to the area between the bridge of the nose and the inner eyelids. A sample of the pus may be collected on a swab or in a tube for laboratory analysis. The type of antibiotic and treatment may depend on which bacteria is present. In the acute form, a blood test may reveal an elevated white blood cell (WBC) count; with a chronic infection, the WBC count is usually normal. To identify the exact location of the blockage, an x ray can be taken after a dye is injected into the duct in a procedure called dacryocystography.

Treatment

A warm compress applied to the area can help relieve pain and promote drainage. Topical and oral antibiotics may be prescribed if an infection is present. Intravenous antibiotics may be needed if the infection is severe. In some cases, a tiny tube (cannula) is inserted into the tear duct which is then flushed with a sterile salt water solution (sterile saline). If other treatments fail to clear up the symptoms, surgery (dacryocystorhinostomy) to drain the lacrimal sac into the nasal cavity can be performed. In extreme cases, the lacrimal sac will be removed completely.

In infants, gentle massage of the lacrimal sac four times daily for up to nine months can drain the sac and sometimes clear a blockage. As the infant grows, the duct may open by itself. If the duct does not open, it may need to be dilated with a minor surgical procedure.

Prognosis

Treatment of dacryocystitis with antibiotics is usually successful in clearing the infection that is present. If there is a permanent blockage that prevents drainage, infection may recur and surgery may be required to open the duct. If left untreated, the infected sac can rupture, forming an open, draining sore.

Prevention

There are no specific recommendations for the prevention of dacryocystitis; however, good hygiene may decrease the chances of infection.