Dacryocystitis is an inflammation of the tear drainage system, located near the inner corner of the eye. This condition can cause discomfort and requires appropriate care.
What is Dacryocystitis
Dacryocystitis is an inflammation or infection of the lacrimal (tear) sac, located in the inner corner of the eye near the nose. This sac is part of the tear drainage system. Tears are produced by the lacrimal gland, located above the eye, and then spread across the eye’s surface with each blink to keep it clean and moist.
Tears drain through small openings called puncta on the inner edges of the eyelids. From the puncta, tears enter tiny tubes called canaliculi, which lead to the lacrimal sac, and finally move down the nasolacrimal duct into the nasal cavity. When this drainage pathway becomes obstructed, tears accumulate in the lacrimal sac, creating an environment where bacteria can multiply, leading to inflammation and infection.
Dacryocystitis can be acute or chronic. Acute dacryocystitis develops suddenly with severe symptoms, often resolving within a few days to less than three months with treatment. Chronic dacryocystitis presents with milder, more gradual symptoms that can persist for a prolonged period, sometimes exceeding three months. The condition can also be congenital, present at birth due to underdeveloped tear ducts, or acquired later in life.
Identifying the Symptoms
Symptoms of dacryocystitis include localized discomfort, pain, redness, and swelling in the inner corner of the eye. Tenderness may be present, and the skin around the affected area might appear discolored or darker.
Excessive tearing, known as epiphora, is a prominent symptom as tears are unable to drain properly. Discharge, which can range from clear fluid to yellow or green pus, may emerge from the puncta or the eye itself. This discharge can also lead to crusting on the eyelids, particularly upon waking.
In acute cases, symptoms tend to be more intense, with greater pain, redness, and swelling. A fever may also accompany acute dacryocystitis. Chronic dacryocystitis often involves persistent tearing and discharge, though pain and fever may be less pronounced or absent.
Causes and Treatment Options
Dacryocystitis is caused by an obstruction within the nasolacrimal duct, which impedes the normal flow of tears from the lacrimal sac into the nasal cavity. This blockage leads to tear stagnation, creating a favorable environment for bacterial overgrowth and subsequent infection. Common bacteria implicated include Staphylococcus and Streptococcus species.
Several factors can increase an individual’s susceptibility to developing dacryocystitis. Age is a significant factor, with infants often affected due to underdeveloped or blocked nasolacrimal ducts at birth. Older adults, particularly those over 40, are also at higher risk due to natural narrowing of the tear ducts over time. Other contributing factors include previous trauma to the face or nose, such as from broken bones or surgeries, and certain medical conditions like sinusitis, tumors in the sinus or nasal passages, or autoimmune diseases. Some medications, including specific blood pressure drugs, glaucoma treatments, and certain cancer therapies, have also been linked to tear duct blockages.
Treatment approaches for dacryocystitis vary depending on the severity and type of the condition. Conservative measures are often the first line of defense, particularly for mild cases or as an adjunct to other treatments. Applying warm compresses to the affected eye for 10 to 15 minutes, several times daily, can help reduce inflammation and pain. Gentle massage of the area may also be recommended to aid drainage.
For bacterial infections, antibiotics are typically prescribed. Oral antibiotics are common, with medications such as amoxicillin-clavulanate, cephalexin, ciprofloxacin, clindamycin, and trimethoprim-sulfamethoxazole often used. In more severe infections, intravenous antibiotics may be administered. Topical antibiotic ointments or drops might also be suggested.
When conservative and antibiotic treatments are insufficient, particularly for persistent blockages or chronic cases, surgical interventions become necessary. For infants with congenital dacryocystitis, a procedure called nasolacrimal duct probing involves inserting a thin probe into the tear duct to open the blockage. For adults, a dacryocystorhinostomy (DCR) is a common surgical procedure. This surgery creates a new drainage pathway between the lacrimal sac and the nasal cavity, bypassing the obstruction and allowing tears to drain properly.
Complications and Recovery
If dacryocystitis is not treated, the infection can spread beyond the tear sac, leading to complications. One potential complication is periorbital cellulitis, where the infection extends to the tissues surrounding the eye. A more severe spread can result in orbital cellulitis, an infection within the eye socket itself, which can pose a threat to vision. In some instances, an abscess, a localized collection of pus, may form in the affected area.
The prognosis for dacryocystitis is generally favorable with timely and appropriate medical intervention. Most individuals recover fully within a few weeks when treated with antibiotics. Following medical or surgical treatment, patients typically experience improvement as the new drainage pathway establishes itself. It is important to adhere to a healthcare provider’s recommendations for follow-up care and to report any worsening symptoms or new concerns promptly.