Dacryocystitis

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

Definition

Dacryocystitis is an infection and inflammation of the lacrimal sac, often caused by a blockage in the nasolacrimal duct. It can be acute or chronic and may lead to pain, redness, and swelling in the inner corner of the eye.

Aetiology

Dacryocystitis is typically caused by bacterial infection due to the stagnation of tears within the lacrimal sac. Common pathogens include:

• Staphylococcus aureus
• Streptococcus pneumoniae
• Haemophilus influenzae
• Pseudomonas aeruginosa

Pathophysiology

The blockage of the nasolacrimal duct prevents normal drainage of tears into the nasal cavity, leading to stagnation and subsequent infection of the lacrimal sac. The infection can cause inflammation, abscess formation, and in severe cases, the spread of infection to surrounding tissues.

Risk Factors

• Chronic sinusitis
• Nasal or sinus surgery
• Trauma to the nasal area
• Congenital nasolacrimal duct obstruction
• Age (more common in older adults)
• Female gender (due to narrower nasolacrimal ducts)

Signs and Symptoms

Common signs and symptoms of dacryocystitis include:

• Pain and tenderness over the lacrimal sac area
• Redness and swelling in the inner corner of the eye
• Epiphora (excessive tearing)
• Pus or discharge from the tear duct
• Fever (in severe cases)

Investigations

• Clinical history and physical examination
• Culture of discharge to identify the causative organism
• Imaging studies (e.g., dacryocystography, CT scan) to assess the extent of duct obstruction and surrounding structures

Management

Primary Care Management

• Antibiotic therapy: Oral antibiotics such as amoxicillin or flucloxacillin for mild to moderate infections
• Warm compresses: To alleviate pain and promote drainage
• Pain management: Analgesics such as paracetamol or ibuprofen
• Referral to an ophthalmologist: For severe infections, abscess formation, or if there is no improvement with initial treatment

Specialist Management

• Intravenous antibiotics: For severe infections requiring hospitalisation
• Incision and drainage: For abscess formation
• Dacryocystorhinostomy (DCR): Surgical procedure to create a new drainage pathway between the lacrimal sac and the nasal cavity, often indicated for chronic or recurrent dacryocystitis
• Regular follow-up to monitor resolution of infection and prevent recurrence

References

1. NICE. (2024). Dacryocystitis: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Dacryocystitis. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Dacryocystitis: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Dacryocystitis. Retrieved from AAO

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