dacryocystit

Dacryocystitis is an inflammation and infection of the lacrimal sac, usually arising from obstruction of the nasolacrimal duct. In adults it is most often due to acquired NLDO from chronic nasal or inflammatory disease, trauma, or mass effect; in infants it may follow congenital NLDO. Common pathogens include Staphylococcus aureus, Streptococcus species, and less often gram-negative organisms.

Clinical presentation varies by form. Acute dacryocystitis presents with sudden swelling and tenderness at the medial canthus over the lacrimal sac, erythema, tearing, mucopurulent discharge, and sometimes fever. Chronic dacryocystitis features persistent tearing with intermittent discharge and a less acutely inflamed sac. Pediatric cases may accompany regurgitation on pressure over the sac.

Diagnosis is clinical. Distinguish from conjunctivitis, canaliculitis, and orbital cellulitis. Imaging is reserved for suspected orbital involvement, atypical cases, or planning surgery, and may include ultrasound, CT, or dacryocystography.

Management centers on treating the infection and addressing the underlying obstruction. Acute cases require systemic antibiotics that cover Staphylococcus species, warm compresses, and sac massage; incision and drainage is needed for abscess. After infection resolves, definitive management of NLDO is considered: in infants, probing or irrigation after 6–12 months; in adults, dacryocystorhinostomy (external or endoscopic) with or without lacrimal intubation. Recurrence is common if NLDO persists.

Prognosis is generally favorable with appropriate treatment, but recurrent infection and complications such as orbital cellulitis or abscess can occur if the obstruction is not corrected.