Dacryocystitis is an inflammation of the lacrimal sac, a small chamber in the inner corner of the eye that helps drain tears into the nasal cavity. When this drainage pathway is blocked, tears accumulate, which can lead to infection. The condition affects all ages, from newborns to older adults, and can be either a sudden, acute infection or a persistent, chronic one.
Causes of Tear Duct Infection
The primary cause of dacryocystitis is a blockage in the nasolacrimal duct. This obstruction prevents tears from draining, creating a stagnant environment where bacteria like Staphylococcus aureus and Streptococcus can multiply. The specific bacteria involved can differ between children and adults.
In infants, the condition is often congenital, caused by a membrane at the end of the tear duct that fails to open after birth. In adults, blockages are acquired over time from various factors.
- Age-related narrowing of the ducts, especially in those over 40
- Chronic sinus infections or nasal abnormalities like a deviated septum
- Inflammatory conditions such as sarcoidosis
- Facial trauma or previous nasal or sinus surgeries
- The formation of small stones (dacryoliths) within the sac
Signs and Symptoms
The symptoms of dacryocystitis depend on whether the infection is acute or chronic. Acute dacryocystitis appears suddenly with pain, redness, and swelling over the inner corner of the eyelid. This area becomes very tender to the touch, and a fever may develop.
Excessive tearing is common, along with a thick, sticky discharge of yellow or white pus from the corner of the eye. This discharge can cause crusting along the eyelids and may lead to blurred vision.
Chronic dacryocystitis has more subtle and persistent symptoms. The main signs are constant tearing and a recurring discharge from the eye, but without the intense pain, redness, and swelling seen in acute cases. Some individuals may experience long-term discomfort in the corner of the eye. The inflammation is less severe, but the underlying blockage remains.
Medical Treatments and Home Care
Treatment is tailored to the infection’s severity and the patient’s age. For mild cases, especially in infants, home care can be effective. This involves applying warm compresses to the area multiple times a day to soothe inflammation. A gentle downward massage over the lacrimal sac can also help open the blockage.
When a bacterial infection is confirmed, antibiotics are the primary treatment. For acute infections, a healthcare provider will prescribe oral antibiotics, such as amoxicillin-clavulanate or cephalexin, to eliminate the bacteria causing the inflammation. In severe cases where the infection is spreading, intravenous antibiotics may be required in a hospital. Topical antibiotic eye drops can also be used with oral medications to manage discharge.
If the condition is persistent or chronic, procedural interventions may be needed. In infants, probing can be performed by passing a thin instrument through the tear duct to clear the obstruction. For adults with chronic blockages, a surgery called dacryocystorhinostomy (DCR) creates a new drainage pathway from the lacrimal sac to the nasal cavity, bypassing the blockage.
Associated Risks and Complications
If left untreated, the infection can worsen and spread. One risk is the formation of an abscess, a collection of pus that creates a painful, swollen lump at the inner corner of the eye. An abscess may require medical drainage to relieve pressure and clear the infection.
A more serious complication is orbital cellulitis, where the infection extends into the tissues surrounding the eye. This is a medical emergency with symptoms like severe eyelid swelling, difficulty moving the eye, vision changes, and high fever. Orbital cellulitis requires immediate antibiotic treatment to prevent lasting damage, including vision loss. Seek prompt medical attention for severe pain, vision changes, or redness spreading across the face.