Dacryocystitis

The lacrimal excretory system is prone to infection and inflammation for various reasons. This mucous membrane-lined tract is contiguous with 2 surfaces (conjunctival and nasal mucosal) that are normally colonised with bacteria. The functional purpose of the lacrimal excretory system is to drain tears from the eye into the nasal cavity. Stagnation of tears in a pathologically closed lacrimal drainage system can result in dacryocystitis.

Acquired dacryocystitis can be acute or chronic.

Acute dacryocystitis is heralded by the sudden onset of pain and redness in the medial canthal region. An insidious onset of epiphora is characteristic of chronic inflammation or infection of the lacrimal sac.
Acute dacryocystitis is manifested by the sudden onset of pain, erythema, and oedema overlying the lacrimal sac region. The tenderness is characteristically localized in the medial canthal region but may extend to the nose, cheek, teeth, and face. More serious sequelae of acute dacryocystitis include extension into the orbit with formation of an abscess and development of orbital cellulitis. When this occurs, it may lead to blindness, cavernous sinus thrombosis, and death.

Tearing is the most common presentation of chronic dacryocystitis and is related to the obstruction of the outflow of tears, debris, and epithelial cells from the surface of the eye.
Cellulitis is seen predominately in acute dacryocystitis and is due to bacterial overgrowth with rupture through the wall of the lacrimal sac into surrounding soft tissue.

The treatment of dacryocystitis depends upon the clinical manifestations of the disease.
Acute dacryocystitis necessitates administration of oral antibiotics (eg Augmentin).
Acute dacryocystitis with orbital cellulitis necessitates hospitalization with intravenous (IV) antibiotics.
Congenital chronic dacryocystitis may resolve with lacrimal sac massage, warm compresses, and topical and/or oral antibiotics.
Chronic dacryocystitis almost always dictates surgery for correction of symptomatology.
In general, dacryocystitis is a surgical disease. Surgical success rates of DCR in the treatment of dacryocystitis are approximately 95%.
For acute dacryocystitis, an external dacryocystorhinostomy is preferred after several days of initiating antibiotic therapy.