Dacryocystitis

What is Dacryocystitis

Dacryocystitis is an infection of the sac that collects tears (lacrimal sac). The lacrimal sac is located between the inner corner of the eye and the nose. The glands of the eyelids make tears that keep the surface of the eye wet and protected.

Tears drain from two small tubes (ducts) in the eyelids. These ducts carry tears to the lacrimal sac. Another tube (nasolacrimal duct) carries tears from the lacrimal sac down into the nose.

Dacryocystitis can be sudden (acute) or long-lasting (chronic). It usually affects only one eye.

What are the causes?

The most common cause of this condition is a blocked nasolacrimal duct. When this duct is blocked, tears cannot drain into the nose, and tears become backed up in the lacrimal sac. Bacteria that normally live in the eye, on the skin, or in the nose start to grow inside the sac and cause infection.

The nasolacrimal duct may become blocked because of:

  • A nose or sinus infection that spreads into the duct.
  • A duct that is abnormally shaped (malformed).
  • A growth or swelling in the nose.
  • An injury or surgery that narrows or scars the duct.

Dacryocystitis also may start as an eye infection that spreads to the lacrimal sac. Sometimes the cause of dacryocystitis is not known.

What increases the risk?

This condition is more likely to develop in people who:

  • Are older than 40.
  • Are female. Women tend to have a narrower nasolacrimal duct than men.
  • Have had nasal trauma, such as a broken nose or nasal surgery.
  • Have nasal polyps.

What are the signs or symptoms?

Symptoms of acute dacryocystitis start suddenly and may include:

  • Excessive tearing.
  • A matted, watery eye.
  • Swelling and redness over the lacrimal sac.
  • Discharge of mucus or pus into the eye. This may cause blurred vision.
  • Eye pain.
  • Fever.

Symptoms of chronic dacryocystitis usually include:

  • Excessive tearing.
  • Discharge of mucus or pus into the eye.
  • Blurred vision.

Redness, pain, and swelling are less common with chronic dacryocystitis.

How is this diagnosed?

This condition is diagnosed based on your medical history and a physical exam. During the exam, your health care provider may press between your eye and the side of your nose to see if discharge flows back into your eye. You may also have tests, such as:

  • Removal of a sample of your eye or nose discharge to check for infection.
  • A dye disappearance test. During this test, your health care provider will put a yellow dye in your eye to see if the dye disappears from your eye. A swab may be placed in your nose to see if the dye drains to your nose.
  • Nasal endoscopy. For this test, a thin, lighted scope (endoscope) is placed in your nose to determine what is causing the duct blockage.

How is this treated?

Acute dacryocystitis is treated with antibiotic medicines. These are usually given by mouth (orally), but they can also be given as eye drops or ointments. If the infection has spread to tissues around the eye (orbital cellulitis), antibiotics may be given through an IV tube. Chronic dacryocystitis usually needs to be treated with surgery. Surgical options include:

  • Probing the duct to open it.
  • Widening the duct.
  • Removing a nasal blockage.

Follow these instructions at home:

  • If directed by your health care provider, apply a clean warm compress to the inside corner of your eye. To do this:
    • Wash your hands first.
    • Hold the compress over the inside corner of your eye for a few minutes.
    • Repeat this every few hours during the day.
  • Take or apply your antibiotic medicine, drops, or ointment as told by your health care provider. Do notstop taking or applying the antibiotic even if you start to feel better.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have a fever.
  • Your symptoms come back, do not improve, or get worse.

Get help right away if:

  • You have redness, swelling, and pain that spread to the tissues around your eye.
  • You have a sudden decrease in your vision.
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