Brief Description, Types, Sign and Symptoms, Causes And Treatment Of Dacryocystitis

Dacryocystitis is simply an inflammation of the lacrimal sac which may be caused by infection. The lacrimal sac helps drain excess tears from the eye. The lacrimal sac starts near the inner corner of the eye and runs along the side of the nose.Tears move through tear ducts into this sac.
The tears are then passed out into the nasal passages. 

Dacryocystitis occurs when tears become trapped in the lacrimal sac due to blocked tear duct. This forms a tear pool which encourages bacterial growth thereby leading to infection. The trapped tears and infection will cause swelling and irritation. The most common bacteria associated with dacryocystitis are staphylococcus aureus and streptococcus pneumonia. Dacryocytitis may come in form of congenital, acute or chronic.

In congenital dacryocystitis, epiphora (watering eyes) develops seven days to six weeks after birth followed by mucopurulent discharge with sticky eyes and crusting eyelids. Pressing the lacrimal sac discharges purulent materials from the lower punctum. Epiphora in newborns can also be caused by ophthalmia neonatorum and congenital glaucoma.

Chronic dacryocystitis is more common and long lasting. It comes with mild redness and swelling of the inner canthal region with little or no pain. Watching eyes (epiphora) is the most presentation. Applying slight and steady pressure on the swelling discharges purulent fluid from the lower punctum.

Acute dacryocystitis comes with sudden onset of pain, redness, oedema, swelling in the region of lacrimal sac, fever and malaise. There is also excessive lacrimation and purulent discharge from the eyes.

Treatment options for congenital dacryocystitis depend on the age of the baby involved. The treatment options include the following:

1. Lacrimal sac massage followed by instillation of topical antibiotics at the age of 6 – 8 weeks. 
2. Lacrimal irrigation with normal saline and antibiotic solution at the age of two months. 
3. Probing of nasolacrimal duct with bowman’s probe under general anaesthesia at the age of 4 – 6 months.
4. Intubation of silicone tube into the nasolacrmal sac at six months of age. 
5. At the age of four years, dacryostorhinostomy (DCR) operations may be performed.

The mainstays of treatment for acute and chronic dacryocystitis include the following:

1. Hot compresses to relief pain and swelling.
2. Topical and oral antibiotics to control infection. Anti-inflammatory and analgesics may also be given.
3. When the pus starts pointing on the skin, it should be drained with a small incision and dressed with betadine soaked roll gauze.
4. Either dacryocystorhinostomy (DCR) or dacryocystectomy (DCT) operation should be carried out.