The lacrimal system is a drainage network that directs tears from the eye surface through tiny openings (puncta) into the lacrimal sac, and then down the nasolacrimal duct into the nasal cavity. When this pathway becomes blocked, tears cannot flow out. The resulting stagnant fluid creates an ideal environment for bacteria to multiply, leading to an infection known medically as Dacryocystitis.
Understanding Dacryocystitis and Its Causes
Dacryocystitis is an infection and inflammation of the lacrimal sac, almost always resulting from an obstruction in the nasolacrimal duct. When the duct is blocked, tears collect in the lacrimal sac instead of draining, allowing bacteria to flourish in the pooled fluid. Common bacterial culprits are typically those found on the skin or in the respiratory tract, such as Staphylococcus and Streptococcus species.
The causes of obstruction vary significantly between age groups. In infants, the blockage is often congenital, caused by a membrane that fails to open fully after birth. For adults, the obstruction is typically acquired, resulting from age-related narrowing of the duct, trauma to the facial bones, or chronic inflammation from conditions like sinusitis. Tumors or nasal polyps can also compress the duct, preventing proper tear flow.
The condition is categorized into acute and chronic forms. Acute dacryocystitis presents suddenly with severe symptoms and is a more aggressive bacterial infection requiring immediate treatment. Chronic dacryocystitis involves a long-term, partial blockage that leads to persistent but milder symptoms, such as constant watering of the eye, and often requires structural correction to prevent recurrent infections.
Recognizing the Symptoms of a Tear Duct Infection
Patients often experience severe pain and tenderness in the inner corner of the eye, near the bridge of the nose. This area usually develops noticeable, localized swelling that may feel like a firm, painful lump beneath the skin. Redness (erythema) is present over the swollen area, sometimes extending to the surrounding skin and eyelids.
The most common symptom is excessive tearing, or epiphora, because the tears cannot drain through the blocked duct. Pressure on the swollen lacrimal sac may cause a thick, yellowish or whitish discharge of pus or mucus to be expelled from the puncta.
Treatment Options and Medical Intervention
Treating an infected tear duct focuses on eliminating the bacterial infection and restoring proper tear drainage. For acute infections, systemic antibiotics are the primary course of action, often starting with oral medications to target common bacterial organisms. In more severe cases, or if the infection is spreading, intravenous antibiotics may be administered in a hospital setting.
Home Care and Massage
Supportive home care is recommended alongside antibiotic treatment to help ease discomfort and inflammation. Applying a clean, warm compress to the area several times a day can help reduce swelling. For infants with congenital blockage, lacrimal sac massage is a non-invasive method used to try and force open the membrane at the end of the duct. This technique involves applying firm, downward pressure over the lacrimal sac to create hydrostatic force.
Surgical Intervention (DCR)
If the infection is recurrent or the blockage is chronic, surgical intervention becomes necessary to establish a permanent drainage route. The definitive surgical procedure is called Dacryocystorhinostomy (DCR). DCR involves creating a new connection between the lacrimal sac and the nasal cavity, bypassing the original obstructed nasolacrimal duct.
This surgery can be performed externally through a small incision on the side of the nose or endoscopically through the nasal passage, which avoids an external scar. A temporary silicone tube, or stent, is often placed in the new opening during the procedure to ensure the channel remains open while the tissue heals.
When to Seek Medical Attention
It is important to seek prompt medical attention if you notice signs of a tear duct infection. Symptoms that require immediate evaluation include a fever, rapid spreading of redness, or changes in vision, as these may indicate a more widespread and dangerous infection like orbital cellulitis.