Dacryocystitis | Causes, Symptoms, and Treatment

Dacryocystitis refers to infection of the lacrimal sac, which is part of the eye’s tear drainage system. Tears from each eye drain through tiny channels (canaliculi) into the lacrimal sac and then into the nasolacrimal duct.

The drainage canals are found at the inner corner of each upper and lower eyelid. They carry tears that have washed the front surface of the eye and empty them into the lacrimal sac (also called the tear sac). From there, tears pass through the nasolacrimal duct into the nasal cavity.

The usual cause of dacryocystitis is a blockage in the nasolacrimal duct, which causes tears to back up into the lacrimal sac. The sac can then become inflamed and swollen, leading to dacryocystitis. This condition often causes tearing, eye redness, and eye discharge.

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How Are Tears Produced?

Tears are produced by the lacrimal glands, located in the upper eyelid above each eye. When we blink, the tears spread evenly over the eye’s surface, keeping it moist and helping to focus light for clear vision.

Tears then drain through the puncta—tiny openings in the upper and lower eyelids. From there, they pass through the canaliculi into the lacrimal sac. After that, tears flow through the nasolacrimal duct into the nasal cavity.

It is estimated that a person produces about 15 to 30 gallons of tears each year. When this drainage system becomes partially or completely blocked, tears cannot drain properly, which can lead to infection.

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Types of Dacryocystitis

Infections of the nasolacrimal system can be classified as acute or chronic, and as congenital or acquired. “Acute” and “chronic” refer to how long the symptoms last, whereas “congenital” and “acquired” refer to when and why the condition began.

Each type of dacryocystitis has its own typical features:

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Symptoms of Dacryocystitis

Symptoms of dacryocystitis are often mild, but in more severe cases it can cause fever, and an abscess (a collection of pus) may form and rupture through the skin. The symptoms of acute and chronic dacryocystitis differ:

Acute dacryocystitis usually presents with a sudden onset of symptoms that develop over several hours to a few days. Symptoms typically appear over the medial canthus (where the upper and lower lids meet) and in the area overlying the lacrimal sac, and can include:

In contrast, the most common symptoms of chronic dacryocystitis are excessive tearing (epiphora) and discharge. People with chronic dacryocystitis may also notice changes in visual clarity because of an abnormal tear film on the eye’s surface.

Although not common, some cases of acute dacryocystitis can lead to serious complications, such as:

The consequences of these complications can be severe, so urgent referral to an ophthalmologist for evaluation is essential.

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Causes and Risk Factors for Dacryocystitis

Dacryocystitis occurs when the nasolacrimal duct becomes blocked. Tears collect in the lacrimal sac and form a stagnant pool. Bacteria can then grow in this pooled fluid and cause infection. Both the trapped tears and the infection lead to swelling and irritation.

Certain factors increase the risk of developing dacryocystitis:

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Diagnosis of Dacryocystitis

Diagnosis of dacryocystitis is based primarily on medical history and physical examination. An eye specialist (ophthalmologist) may order additional tests to rule out other conditions and confirm the diagnosis. Different tests may be used depending on the suspected type of dacryocystitis. People with chronic dacryocystitis may need blood tests (serologic tests) when a systemic disease is suspected.

For example, antineutrophil cytoplasmic antibody (ANCA) testing can help evaluate for granulomatosis with polyangiitis (Wegener’s granulomatosis), while antinuclear antibody (ANA) and double-stranded DNA (dsDNA) tests may be used if lupus is suspected. In acute cases, a Crigler massage can be performed to obtain a sample for culture and Gram stain.

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Treatment of Dacryocystitis

Treatment focuses on correcting the underlying cause of dacryocystitis. In infants, management is usually more conservative, since congenital dacryocystitis often resolves on its own by around one year of age. Treatment options also vary depending on the type of dacryocystitis.

Some home measures can help relieve symptoms and support treatment of acute dacryocystitis, such as:

Key surgical procedures include:

Surgery is usually used to treat chronic dacryocystitis. There are different surgical options, and patients should discuss with their healthcare provider which procedure is most appropriate, such as dacryocystorhinostomy (DCR) and related techniques.

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Regardless of the type of eye disease or the degree of eye problems, this delicate medical condition requires thorough examination and proper treatment by a skilled, experienced ophthalmologist, using effective medical tools that ensure positive outcomes. Whatever eye condition you are experiencing, you can book an appointment at Batal Specialized Medical Complex for a comprehensive eye examination and to begin treating eye problems, no matter how complex they may be.

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