Tear duct infection (acute dacryocystitis)

Acute dacryocystitis is an infection of the lacrimal tear sac which is usually caused by a blocked nasolacrimal duct (see TEARING IN ADULTS section). More rarely the infection is secondary to stones (dacryoliths) in the lacrimal sac plugging the opening to the duct. Once the nasolacrimal duct is occluded tears +/- mucous can build up in the lacrimal sac. Lack of proper drainage results in tear stagnation and consequently the blocked system becomes prone to infection. For anatomical reasons the left side is more commonly affected that the right.

How does acute dacryocystitis present?

Typically the nasolacrimal duct does not block up suddenly, but rather there is a gradual narrowing of the drainage system over months or years. Consequently patients with acute dacryocystitis often have a history of gradually worsening watery eyes (epiphora).

The symptoms of acute dacryocystitis are:

• Sudden development of a painful, warm, red swelling between the inner corner of the eye and the side of the nose.
• The swelling may extend to involve the eyelids and upper cheek (cellulitis).
• There may be an associated red sticky eye
• The abscess may become so tense that it "bursts" through the skin, allowing pus to drain out of the infected lacrimal sac before forming a scab.

Treatment of acute dacryocystitis

The initial treatment is oral or intravenous antibiotics to try and reduce the infection. Although this often helps in the short term it is not tackling the underlying cause and therefore without further intervention the problem is likely to recur. It is tempting to drain the abscess through the skin but this is generally not recommended as it is likely to result in a fistula developing between the lacimal sac and the skin surface.

The best option to treat the dacryocystitis, and at the same time deal with the underlying cause of an occluded nasolacrimal duct, is to undertake a Dacryocystorhinostomy (DCR) (see TEAR DUCT SURGERY section). It is usually desirable to undertake a DCR within 6 weeks of the acute episode and the procedure generally has a high chance of success.

Some people present with a watery eye and painless swelling between the corner of the eye and the side of the nose. This is due to a Chronic dacryocystitis which is also secondary to a blocked nasolacrimal duct. In this instance the lacrimal sac is swollen with mucous but there is no additional infection. Although this situation can occasionally be managed conservatively, the patient is at risk of developing an acute infection, and the definitive treatment is again a DCR.