Dacryocystitis

Dacryocystitis is an inflammation of the tear sac (lacrimal sac) at the inner corner of the eye.

A common infection, dacryocystitis may be acute or chronic. In adults, this infection of the lacrimal sac may follow an obstruction (dacryostenosis) of the nasolacrimal duct (most prevalent in women over age 40) or trauma. In infants, it results from congenital atresia of the nasolacrimal duct. Usually unilateral, dacryocystitis can also be bilateral.

Causes

The infection is usually caused by blocked nasolacrimal ducts (also called dacryostenosis). In children who have dacryocystitis, tears are unable to drain from the lacrimal sac, so they pool in the eye and allow bacteria to grow, leading to infection.

The most common infecting organism in acute dacryocystitis is Staphylococcus aureus or, occasionally, beta-hemolytic streptococcus. In chronic dacryocystitis, Streptococcus pneumoniae or, sometimes, a fungus ­such as Candida albicans - is responsible for the infection.

Signs and Symptoms

• Generally affects one eye
• Excessive tearing
• Tenderness, redness, and swelling
• Discharge
• Red, inflamed bump on the inner corner of the lower lid

Diagnostic tests

Tests used for this condition typically include cultures of exudate to identify the pathogen, typically S. aureus and, occasionally, beta-hemolytic streptococcus in acute dacryocystitis and S. pneumoniae or C. albicans in chronic disease. The white blood cell count may increase in acute disease; it's usually normal in chronic dacryocystitis. Dacryocystography can be used to locate the site of congenital atresia.

Treatment

Topical and systemic antibiotics and warm compresses may relieve acute dacryocystitis. Chronic dacryocystitis may eventually require dacryocystorhinostomy.

For nasolacrimal duct obstruction in an infant, treatment consists of carefully massaging the lacrimal sac area four times daily until the infant is 8 or 9 months old. At that time, the obstruction commonly resolves spontaneously. If massage fails to open the duct, dilating the punctum and probing the duct may be necessary.

Prevention

There are no specific recommendations for the prevention of dacryocystitis, however, good hygiene may decrease the chances of infection.

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