An infection of the tear sac
Dacryocystitis is an infection of the lacrimal sac, the small pouch that sits between the inner corner of the eye and the nose, acting as a reservoir for tears as they drain from the eye surface into the nasal cavity.
When the duct below the lacrimal sac becomes blocked, tears cannot drain properly and pool within the sac. Stagnant tears create conditions in which bacteria can multiply, and this is when infection develops. The result is dacryocystitis.
Pain, redness, and swelling at the inner corner of the eye
Acute dacryocystitis typically announces itself with pain, redness, and swelling at the inner corner of the eye, specifically in the area just below the inner corner of the lower eyelid, where the lacrimal sac sits. There may be a tender, warm lump in this area, along with discharge from the eye.
In more severe cases, there may be a fever and a general feeling of being unwell. The eye itself often waters or produces a sticky discharge even before the full infection takes hold, as a consequence of the underlying drainage blockage.
Two different presentations of the same underlying problem
Acute dacryocystitis is the infected, inflamed form described above. It comes on over hours to days and is usually quite painful. It requires prompt treatment with antibiotics.
Chronic dacryocystitis is a lower-grade, longer-lasting form in which the lacrimal sac remains persistently inflamed without a full acute infection. Chronic dacryocystitis typically causes a persistently watery eye and intermittent discharge rather than pain and swelling, and it may smoulder for months before being identified as the cause. In some cases, gentle pressure over the area of the lacrimal sac causes mucus or discharge to appear at the punctum, a distinctive and diagnostically useful sign.
Usually age-related narrowing of the tear duct
In adults, the most common underlying cause is age-related narrowing of the nasolacrimal duct, the passage that runs from the lacrimal sac down into the nose. This narrowing tends to develop gradually and may cause persistent watering for some time before dacryocystitis develops.
In infants and young children, dacryocystitis can occur in the context of a congenital blockage of the nasolacrimal duct, a common condition in which the lower end of the duct fails to open fully at birth. Most congenital blockages resolve spontaneously during the first year of life.
- A painful, red, swollen lump at the inner corner of the eye
- Fever alongside eye or eyelid swelling
- Swelling that is spreading rapidly towards the eyelid or cheek
Antibiotics first, then surgery to address the blockage
Acute dacryocystitis is initially treated with antibiotics, usually oral, though intravenous antibiotics may be needed in severe cases. If a collection of pus forms within the sac, it may need to be drained.
Once the acute infection has settled, the underlying duct blockage needs to be addressed to prevent recurrence. This is typically done with a surgical procedure called dacryocystorhinostomy (DCR), which creates a new drainage pathway between the lacrimal sac and the nasal cavity, bypassing the blocked nasolacrimal duct. DCR has an excellent success rate and is the definitive treatment for this condition.
Frequently asked questions
What causes dacryocystitis?
Dacryocystitis is caused by an infection in the lacrimal sac, which develops when the nasolacrimal duct becomes blocked and tears stagnate within the sac. In adults, the blockage is most commonly age-related. In infants, it is usually due to a congenital failure of the duct to open fully.
How is dacryocystitis treated?
Acute dacryocystitis is treated initially with antibiotics. Once the infection has resolved, the underlying duct blockage is typically addressed with a surgical procedure called dacryocystorhinostomy (DCR), which creates a new drainage pathway between the lacrimal sac and the nasal cavity.
What is the difference between acute and chronic dacryocystitis?
Acute dacryocystitis comes on over hours to days with pain, redness, and swelling at the inner corner of the eye. Chronic dacryocystitis is a lower-grade, persistent form that causes watering and intermittent discharge without the severe pain and swelling of the acute form.
Will dacryocystitis come back?
Without treating the underlying blockage, dacryocystitis is likely to recur. Antibiotics treat the infection but do not resolve the blockage that caused it. Definitive treatment with DCR surgery, which creates a new drainage pathway, significantly reduces the risk of recurrence.
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