Dacryocystitis

Dr Ben Wild

Overview

The lacrimal system starts with the lacrimal gland and 2 other accessory glands that produce the watery (aqueous) portion of the tears responsible for oxygen transmission, removal of debris, antimicrobial activity, and optimal optical performance. The tears then pool along the lower eyelid margin and migrate towards the nose towards 2 small holes, one on the upper lid and one lower, called the puncta. These puncta connect to the canalicular canals which connect to the nasolacrimal sac and then into the nose. That is why when you cry, your nose starts to run.

Frontal view of a healthy eye.

Dacryocystitis occurs when the nasolacrimal duct, or sac in the nose, becomes infected or inflamed. This can lead to a nasolacrimal duct obstruction. This usually presents unilaterally (in one eye) as a tender, sometimes painful, red bump immediately below the nasal corner of the eye, by the nose. It can be present all of a sudden and last for under 3 months (acute) or remain for much longer (chronic). It can also be seen congenitally (at birth).

Frontal view showing inflamed nasolacrimal duct and inner canthus with dacryocystitis.

Signs and Symptoms

Signs

Large bump or area of swelling immediately below the nasal corner of the eye, often red, swollen canthus (inner corner of the eye), mucous discharge emanating from the puncta.

Symptoms

Pain (if acute), tenderness, heat, epiphoria (excessive tearing).

Causes and Risk Factors

Causes

Acute	Nearby infections, preseptal cellulitis, sarcoidosis, trauma, surgeries, tumors, medications.
Chronic	Associated with chronic conjunctivitis.
Congenital	Born with an incomplete nasolacrimal duct opening.

Risk Factors

Nearby infections of conjunctiva, cornea, sinuses or inflammation.

Prevention and Treatment

Prevention

There are no known preventative measures.

Treatments

Acute	Warm compresses of bump to try and open the obstruction, dilation and irrigation procedure, oral antibiotics, surgery.
Chronic	Surgery.
Congenital	Usually wait until the nasolacrimal duct fully develops on it’s own, warm compresses, dilation and irrigation procedure, surgery.

Prognosis

Dacryocystitis can be quite irritating and is often difficult to treat non-surgically. Thankfully, it is not known to be a threat to vision.