Dacryocystitis is infection of the lacrimal sac that sometimes leads to abscess formation. The usual cause is a staphyloccocal or streptococcal species, typically as a consequence of nasolacrimal duct obstruction.
Tears are produced by the main and accessory lacrimal glands and collected in the punctum. From the punctum, the tears drain through the canaliculi, through the nasolacrimal duct into the nose. The main lacrimal gland is responsible for reflex tearing, when the eye gets irritated by a foreign body or from cutting an onion. Accessory lacrimal glands keep the eye constantly lubricated.
Where Tears Come From
Acute dacryocystitis
In acute dacryocystitis, the patient presents with pain, erythema, and edema around the lacrimal sac. Diagnosis is suspected based on symptoms and signs and when pressure over the lacrimal sac causes reflux of mucoid material through the puncta.
Initial treatment is with warm compresses and oral antibiotics for mild cases or IV antibiotics for severe cases. The antibiotic is usually a first-generation cephalosporin or penicillinase-resistant synthetic penicillin. If the infection does not respond as expected, consideration should be given to methicillin-resistant Staphylococcus aureus (MRSA), and antibiotics changed accordingly. The abscess can be drained and the antibiotics can be changed based on culture results if the initial antibiotic proves ineffective. There is some evidence that early surgery (endoscopic dacryocystorhinotomy) is effective for the treatment of acute dacryocystitis and hastens resolution (1).
Photo courtesy of James Garrity, MD.
Chronic dacryocystitis
Patients with chronic dacryocystitis usually present with a mass under the medial canthal tendon and chronic conjunctivitis. Definitive treatment for resolved acute dacryocystitis or chronic conjunctivitis is usually surgery that creates a passage between the lacrimal sac and the nasal cavity (dacryocystorhinostomy).
Photo courtesy of James Garrity, MD.
General reference
1. Lilja M, Leivo T, Uusitalo M, Vet S, al: Acute versus late endoscopic dacryocystorhinostomy in treatment of acute dacryocystitis: A prospective randomised trial with an 18-month follow-up. Acta Ophthalmol 2023 Sep 14. doi: 10.1111/aos.15752
