Dacryocystitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Dacryocystitis is an infection of the lacrimal sac, typically caused by obstruction of the nasolacrimal duct, leading to pain, swelling, and discharge from the medial canthus of the eye.

Aetiology

  • Nasolacrimal duct obstruction: congenital in infants, acquired in adults.
  • Bacterial infection: Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae.
  • Chronic inflammation: secondary to sinus disease, allergies, or trauma.
  • Secondary causes: post-surgical scarring, neoplasms.

Pathophysiology

  • Obstruction of the nasolacrimal duct leads to tear stasis and bacterial overgrowth.
  • Infection causes inflammation, swelling, and purulent discharge.
  • Severe cases may result in abscess formation or progression to orbital cellulitis.

Risk Factors

  • Congenital nasolacrimal duct obstruction (infants).
  • Chronic sinusitis or rhinitis.
  • Facial trauma or previous surgery affecting the nasolacrimal system.
  • Immunosuppression (e.g., diabetes, HIV).

Signs and Symptoms

  • Pain, swelling, and redness over the lacrimal sac region (medial canthus).
  • Epiphora (excessive tearing).
  • Purulent discharge, especially on lacrimal sac pressure.
  • Fever and systemic symptoms in severe cases.

Investigations

  • Clinical diagnosis: based on history and examination.
  • Swab for culture: if discharge is present, guides antibiotic therapy.
  • Imaging (CT or MRI): if abscess formation or orbital involvement suspected.

Management

1. Conservative Management:

  • Warm compresses to the affected area.
  • Gentle massage of the lacrimal sac to encourage drainage.

2. Antibiotic Therapy:

  • Oral antibiotics (e.g., co-amoxiclav) for mild cases.
  • IV antibiotics (e.g., ceftriaxone) if signs of systemic infection or orbital involvement.

3. Surgical Intervention:

  • Incision and drainage: for abscess formation.
  • Dacryocystorhinostomy (DCR): for recurrent or chronic cases.
  • Probing and irrigation: for congenital cases failing to resolve by 12 months.

4. Referral:

  • Ophthalmology: for persistent or recurrent cases, or if surgical intervention is required.
  • Paediatrics: if congenital dacryocystitis does not resolve with conservative measures.
  • ENT: if nasal obstruction contributes to nasolacrimal duct dysfunction.
Eye DiseasesmypanotesDacryocystitis