Dacryocystitis

What is dacryocystitis?

Dacryocystitis (pronounced “dak-ree-oh-sis-ty-tus”) is the medical term for the inflammation and infection of your tear sac. The sac is also called the lacrimal sac and leads to your tear duct (nasolacrimal duct). These are all parts of your tear system.

When the system works the way it’s supposed to, your tears will flow from your eyes into the duct and through to your nasal passages.

Dacryocystitis happens because the pathway is blocked. The blockages can be found in the sac, in the passages that the tears use to move or in the nasolacrimal duct. When it can’t move, the fluid containing the tears can become stagnant and infected.

What is the difference between acute and chronic dacryocystitis?

There are two kinds of dacryocystitis — acute and chronic. In general, the difference is one of time. Acute dacryocystitis comes on suddenly and resolves quickly, generally under three months. Chronic dacryocystitis lasts for a long period of time.

Another difference is that chronic dacryocystitis is more often linked to systemic (whole body) and autoimmune conditions. These include granulomatosis with polyangiitis, sarcoidosis and lupus (also called systemic lupus erythematosus). People who have chronic dacryocystitis may also have chronic conjunctivitis (pink eye).

The types of pathogens (harmful agents, like bacteria or viruses) may differ between the two types.

Are there other types of dacryocystitis?

In addition to chronic and acute dacryocystitis, the condition can be congenital (present at birth) or acquired.

Congenital dacryocystitis happens mostly because amniotic fluid doesn’t completely leave the tear system after a baby is born. Neonatal dacryocystitis happens when this fluid becomes infected.

Acquired dacryocystitis happens because of other factors that may include broken bones, surgeries, tumors or using certain medicines.

How common is dacryocystitis?

About 6% of babies born have congenital nasolacrimal duct obstruction (NLDO). Dacryocystitis happens in about 1 in 3,884 live births. It’s more common in females than in males because their passageways are narrower.

What are the signs and symptoms of dacryocystitis?

Signs and symptoms of dacryocystitis can include:

• Eye pain.
• Swelling around your eye.
• Redness or skin darkening.
• An abscess or sore that may have discharge (pus) in the inner corner of your eyelids.
• Fever.

Signs and symptoms of chronic dacryocystitis may be less severe than those of acute dacryocystitis. With the chronic form, you may have watery eyes and no fever.

What causes dacryocystitis?

A blockage in your tear duct causes dacryocystitis. These blockages disrupt the flow of tears from your eyes into your nasal cavity.

A membrane that blocks the duct causes the blockage in newborns. In children and older people, blockages can be caused by many things.

Factors that lead to acquired dacryocystitis include:

• Getting older. Dacryocystitis often happens in adults over 40 years of age.
• Trauma, like that from broken bones or surgeries on your nose.
• Other medical conditions like those involving your immune system or other types of inflammations or infections like sinusitis.
• Having an unusual nasal structure.
• Tumors.
• Certain drugs. These include the blood pressure medication timolol, the glaucoma drugs dorzolamide and pilocarpine, the antiviral trifluridine and cancer treatments such as fluorouracil, docetaxel or radioactive iodine.
• Retained punctal plugs.

Is dacryocystitis contagious?

Even though dacryocystitis may involve an infection, you’re not likely to be contagious.

How is dacryocystitis diagnosed?

Your healthcare provider may have an idea about your condition by the way your eyes look, if your nose is affected and the answers you give to questions about your medical history.

Testing may include:

• Doing an eye exam.
• Pressing the swollen area and finding that discharge comes out through the punctum in your eye (the hole at the corner where tears collect).
• Taking a sample of any discharge to culture in the lab to find out which germ is causing the infection.
• Taking a blood sample to check the level of white blood cells. (Higher counts can mean you have an infection.) Your provider may also use blood tests to find the underlying cause of the eye condition.
• Using a yellow dye placed in your eye to see if it follows that natural pattern of tears. If it takes a long time to disappear, you may have a blockage. If the dye appears on a swab in your nose, you may have a partial blockage.
• Imaging tests to help discover underlying causes of dacryocystitis.

Extra testing may be especially necessary if you’ve had blood in your tears (hemolacria) or troubles with your vision.

How is dacryocystitis treated?

If you have acute dacryocystitis caused by bacteria, your provider will prescribe oral or intravenous (IV, or in the vein) antibiotics. They might also suggest antibiotic ointment or drops.

Using warm compresses can relieve some of the symptoms. You might also try gently massaging the area. You should feel better a few days after starting antibiotics.

These antibiotics can treat tear duct infections:

• Amoxicillin-clavulanate.
• Cephalexin.
• Ciprofloxacin.
• Clindamycin.
• Trimethoprim-Sulfamethoxazole.

Babies with neonatal dacryocystitis who have recurrent episodes will likely outgrow the condition in about a year.

Your provider may suggest surgery called dacryocystorhinostomy (DCR) after you take the antibiotics if you have acute dacryocystitis. DCR is the primary way that providers treat chronic dacryocystitis. The DCR surgery creates a new pathway for your tears.

Complications related to dacryocystitis treatment

There are some complications that can result from DCR, including:

• Excessive bleeding.
• Infection.
• Sinusitis.
• Injuries to parts of your eyes or nose.

How can I prevent dacryocystitis?

There’s nothing you can do to prevent most forms of dacryocystitis. However, you can try to avoid infections by practicing good hand washing methods and keeping your hands away from your eyes. You can also take care to avoid being in crowds or around people who are sick.

What can I expect if I have dacryocystitis?

Some episodes of dacryocystitis will resolve, but you should always check with your healthcare provider or your child’s provider if you have any of the symptoms of dacryocystitis.

Untreated dacryocystitis can lead to an open sore and possible vision issues if it’s not treated.

When should I see my healthcare provider about dacryocystitis?

Always contact a healthcare provider if you have any of the signs or symptoms of dacryocystitis or if your child has any of these symptoms.

What is the difference between dacryoadenitis and dacryocystitis?

These conditions are similar but the inflammation/infection occurs in different locations. The sickness centers in the tear duct in dacryocystitis. The sickness centers in the lacrimal gland in dacryoadenitis.

A note from Cleveland Clinic

If you find that you have discomfort around your eye, and a lump forming at the inside corner of your eye near the bridge of your nose, you should contact a healthcare provider. It could be an inflammation and possible infection of your tear duct, an illness called dacryocystitis. You need to see a healthcare provider for prompt treatment.