Dacryocystitis is an inflammation of the tear sac (lacrimal sac) at the inner corner of the eye.
Tears drain into little openings (puncta) in the inner corners of the eyelids. From there, the tears travel through little tube-like structures (canaliculi) to the lacrimal sac. The nasolacrimal ducts then take the tears from the lacrimal sac to the nose. That's why people need to blow their nose when they cry a lot.
Dacryocystitis is usually caused by a blockage of the nasolacrimal duct, which allows fluid to drain into the nasal passages. When the lacrimal sac does not drain, bacteria can grow in the trapped fluid. This condition is most common in infants and people over 40 years old.
Causes and symptoms
In newborn infants, the nasolacrimal duct may fail to form an opening—a condition called dacryostenosis. The cause of dacryocystitis in adults is usually associated with inflammation and infection in the nasal region. Dacryocystitis can be acute, having a sudden onset, or it can be chronic, with symptoms occurring over the course of weeks or months. Symptoms of acute dacryocystitis can include pain, redness, tearing, and swelling at the inner corner of the eye by the nose. In chronic dacryocystitis, the eye area may be swollen, watery or teary, and, when pressure is applied to the area, there may be a discharge of pus or mucus through the punctum.
Dacryocystitis usually occurs in only one eye. As mentioned, the symptoms can range from watery eyes, pain, swelling, and redness to a discharge of pus when pressure is applied to the area between the bridge of the nose and the inner eyelids. A sample of the pus may be collected on a swab or in a tube for laboratory analysis. The type of antibiotic and treatment may depend on which bacteria is present. In the acute form, a blood test may reveal an elevated white blood cell (WBC) count; with a chronic infection, the WBC count is usually normal. To identify the exact location of the blockage, an x ray can be taken after a dye is injected into the duct in a procedure called dacryocystography.
A warm compress applied to the area can help relieve pain and promote drainage. Topical and oral antibiotics may be prescribed if an infection is present. Intravenous antibiotics may be needed if the infection is severe. In some cases, a tiny tube (cannula) is inserted into the tear duct which is then flushed with a sterile salt water solution (sterile saline). If other treatments fail to clear up the symptoms, surgery (dacryocystorhinostomy) to drain the lacrimal sac into the nasal cavity can be performed. In extreme cases, the lacrimal sac will be removed completely.
In infants, gentle massage of the lacrimal sac four times daily for up to nine months can drain the sac and sometimes clear a blockage. As the infant grows, the duct may open by itself. If the duct does not open, it may need to be dilated with a minor surgical procedure.
Treatment of dacryocystitis with antibiotics is usually successful in clearing the infection that is present. If there is a permanent blockage that prevents drainage, infection may recur and surgery may be required to open the duct. If left untreated, the infected sac can rupture, forming an open, draining sore.
There are no specific recommendations for the prevention of dacryocystitis; however, good hygiene may decrease the chances of infection.
"Lacrimal Apparatus." In The Merck Manual of Diagnosis and Therapy. 16th ed. Ed. Robert Berkow. Rahway, NJ: Merck Research Laboratories, 1992.
Eckman, Margaret, and Nancy Priff, eds. "Disorders of the Eyelids and Lacrimal Ducts." In Diseases. 2nd ed. Spring-house, PA: Springhouse Corporation, 1997.
Gorbach, Sherwood L., John G. Bartlett, and Neil R. Blacklow, eds. "Dacryocystitis." In Infectious Diseases. 2nd ed. Philadelphia: W. B. Saunders Co., 1998.
"Dacryocystitis." In Current Medical Diagnosis and Treatment, 1998. 37th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1997.
Altha Roberts Edgren
Canaliculi—Also known as lacrimal ducts, these tube-like structures carry the tears from the eyes to the lacrimal sac.
Cannula— A narrow tube that can be inserted into a duct.
Dacryocystography—An x ray of the tear duct after injection of a dye that is used to help locate a blockage in the duct.
Dacryocystorhinostomy—A surgical procedure to drain the tear sac into the nasal passage.
Dacryostenosis—Obstruction or narrowing of the nasolacrimal duct. May be present at birth.
Nasoacrimal duct—The tube that carries the tears from the lacrimal sac to the nose.
Punctum—Tiny opening at the inner corners of the upper and lower lids. The area for the beginning of tear drainage.