Dacryocystitis

Dacryocystitis is an infection of the tear sac that lies between the inner corner of the eyelids and the nose. Dacryocystitis may occur suddenly (acute) or be longstanding (chronic). In acute infection, the area around the lacrimal sac is painful, red, and swollen. Stagnation of tears in a pathologically closed lacrimal drainage system can result in dacryocystitis. This is the location of the lacrimal sac, which is part of the nasolacrimal duct (tear drainage system). Sometimes, an infection causes fluid to be retained in the lacrimal sac; a large fluid-filled lacrimal sac is called a mucocele. The lacrimal sac lies in the bony lacrimal fossa derived from the lacrimal and maxillary bones. Symptoms of dacryocystitis include pain, swelling, redness, tenderness, and increased tearing in the lacrimal sac area. White, yellow, or tan drainage that looks like pus may also be present. Surgical correction of the underlying abnormality, if present, is usually necessary once the infection has resolved This condition is treated with oral or IV antibiotics , depending on the severity, sometimes with hospitalization. Incision and drainage of the abscess may be necessary. Dacryocystitis is a congenital condition occurring in up to one third of newborns. For chronic infections, the blocked nasolacrimal duct may be opened with a probe or by surgery. In rare instances, surgical removal of the entire lacrimal sac may be necessary.

The lacrimal sac is a small chamber into which tears drain. inflammation and infection of the lacrimal sac, usually stemming from obstruction of the flow of tears into the nose. It is usually caused by a blockage in the tear duct. This condition most commonly presents when there is obstruction in the tear drainage pathways or a stone in the lacrimal sac. Babies often have recurrent episodes of infection; however, in most cases, the problem resolves as the child grows. Slight pressure applied to the lacrimal sac may push pus through the opening at the inner corner of the eye, near the nose. The lacrimal bone forms the medial wall superiorly, and the inferior concha of the ethmoid bone forms the medial wall of the canal inferiorly. Tear dicts also can become blocked after trauma to the nose or eyes, such as a broken nose,or by nasal polyps.Chronic dacryocystitis may require treatment to relieve tear duct blockage. Incision and drainage of the abscess may be necessary. This would typically involve a procedure known as dacryocystorhinostomy (DCR).

Causes of Dacryocystitis

The common Causes of Dacryocystitis :

• Structural abnormalities of the midface also should be considered.
• Obstruction of the nasolacrimal duct by a tight inferior meatus has been noted in many infants.
• Vasomotor rhinitis
• Nasal inflammation ( see Cold-like symptoms )
• Blocked tear duct
• Much of the time it is difficult to know that this condition is even occurring making it even more severe when it is finally detected.
• Age-related changes affecting the eyes and eyelids in older adults.
• Injury to the nose.
• Dacryocystitis is treated with antibiotic eye drops or ointment and oral or intravenous antibiotics if necessary.
• The most common organisms isolated from the lacrimal sacs of children with dacryocystitis include Staphylococcus aureus, Haemophilus influenzae, beta-hemolytic streptococci, and pneumococci.

Symptoms of Dacryocystitis

Some common Symptoms of Dacryocystitis :

• Generally affects one eye
• Tenderness, redness, and swelling
• Red, inflamed bump on the inner corner of the lower lid
• Redness of inner corner of eye
• Swelling near inner corner of eye
• Watery eye
• painful eye
• excess tearing (usually one eye)
• Discharge
• pus near inner corner of eye

Treatment of Dacryocystitis

• Antibiotic ointments
• Tear duct irrigation
• Surgery to open tear duct
• Antibiotic eyedrops
• Blood cultures and cultures of the lacrimal secretions should be obtained prior to antibiotic therapy.
• If other treatments fail to clear up the symptoms, surgery (dacryocystorhinostomy) to drain the lacrimal sac into the nasal cavity can be performed. In extreme cases, the lacrimal sac will be removed completely.
• Treatment with warm compresses may aid in resolution of the disease.
• Occasionally, infracting of the inferior turbinate bone, submucuous resection of the turbinate, and/or lacrimal outflow probing may be successful treatment of dacryocystitis
• If there is a permanent blockage that prevents drainage, infection may recur and surgery may be required to open the duct.