Acute dacryocystitis is an infection affecting the lacrimal sac, a small chamber situated near the inner corner of your eye, beneath the skin. This sac is a component of your tear drainage system, where tears collect after lubricating the eye. When infected, it causes a sudden onset of symptoms.
What Causes Acute Dacryocystitis
Acute dacryocystitis commonly develops when there is a blockage in the nasolacrimal duct, also known as the tear duct. This duct serves as the drainage pathway for tears from the lacrimal sac into the nasal cavity. When this pathway is obstructed, tears cannot drain properly and accumulate within the lacrimal sac. This stagnation creates an environment where bacteria can multiply, leading to an infection.
Blockages can arise from various factors. In infants, it might be due to a congenital issue, such as a membrane persisting at the end of the nasolacrimal duct. For adults, common causes include age-related narrowing of the duct, trauma, inflammation, or the formation of tear duct stones (dacryoliths). Bacteria frequently implicated in these infections include Staphylococcus aureus and Streptococcus pneumoniae in adults, while Haemophilus influenzae can also be a culprit in children.
Risk factors for developing acute dacryocystitis include being an infant or an older adult, particularly females over 40. Previous nasal or facial surgery, as well as chronic sinus problems, can also increase susceptibility to these blockages and subsequent infections.
Recognizing the Signs and Diagnosis
When acute dacryocystitis occurs, it causes a sudden onset of specific symptoms. These often include pain, redness, and swelling in the area around the lacrimal sac, located at the inner corner of the eye. The redness can sometimes extend towards the bridge of the nose.
Excessive tearing is also common, and a pus-like discharge may be expressed from the tear duct openings (puncta) with pressure on the lacrimal sac. A fever may also develop, indicating a systemic infection. Doctors usually diagnose acute dacryocystitis through a physical examination. They will observe the swelling and tenderness at the inner corner of the eye and may gently press on the lacrimal sac to check for the presence of pus. Imaging like CT scans is generally not needed for routine diagnosis but may be considered in complicated cases or to rule out other conditions.
Treatment Approaches
Treatment for acute dacryocystitis focuses on clearing the infection and restoring tear drainage. Oral antibiotics are typically the first line of treatment for the bacterial infection. Completing the prescribed course of antibiotics is important to fully eradicate the infection.
Supportive measures, such as warm compresses and gentle massage of the lacrimal sac, can help reduce swelling and encourage drainage. These actions aim to alleviate discomfort and assist the body’s natural processes. In more severe cases, if an abscess, which is a collection of pus, forms within the lacrimal sac, a medical professional might need to perform an incision and drainage procedure. This surgical intervention helps to release the trapped pus and provide immediate relief.
For recurrent or chronic dacryocystitis, dacryocystorhinostomy (DCR) may be considered. This procedure creates a new pathway for tears to drain directly from the lacrimal sac into the nasal cavity, bypassing the original blocked duct. The goal of DCR surgery is to establish a clear and functional drainage route, preventing future tear stagnation and infection.
Preventing Recurrence and Recovery
Preventing recurrence involves maintaining good eyelid hygiene and addressing any underlying nasal issues that might contribute to tear duct blockages. Prompt treatment of any new symptoms is also important. After acute treatment or surgery, recovery typically involves continued use of prescribed eye drops, such as antibiotics or anti-inflammatory drops, and follow-up appointments with a healthcare provider to monitor healing and ensure proper tear drainage.
Leaving acute dacryocystitis untreated can lead to serious complications. The infection can spread to surrounding tissues, potentially causing orbital cellulitis, which is an infection of the soft tissues around the eye, or even an orbital abscess. In rare instances, particularly in children, the infection could spread further, leading to meningitis, an infection of the membranes surrounding the brain and spinal cord. Seeking timely medical attention is important to prevent these severe outcomes.