dacryocystitis

Dacryocystitis is an inflammation of the lacrimal sac, usually arising from obstruction of the nasolacrimal duct with secondary infection. It can be classified as acute or chronic. Acute dacryocystitis typically presents with rapid onset of tenderness and swelling at the inferomedial aspect of the orbit near the lacrimal sac, redness over the lacrimal sac area, fever, malaise, and purulent discharge from the punctum. Chronic dacryocystitis features tearing (epiphora), intermittent mucopurulent discharge, a palpable medial canthal mass, and recurrent conjunctival irritation.

Causes include congenital nasolacrimal duct obstruction in infancy and acquired narrowing or blockage in adults due to chronic inflammation, trauma, prior infections, sinus disease, or less commonly tumors. The obstruction allows bacterial infection to ascend and involve the lacrimal sac.

Diagnosis is primarily clinical, supported by ocular examination. Syringing or irrigation of the lacrimal system assesses patency. Imaging, such as dacryocystography or CT/MRI, may be used in planning surgery, evaluating concurrent sinus disease, or in atypical or complicated cases. Differential diagnosis includes conjunctivitis, canaliculitis, and orbital conditions. Complications can include orbital or preseptal cellulitis and, rarely, abscess formation or sepsis.

Management differs by type. Acute dacryocystitis usually requires systemic antibiotics effective against common organisms (eg, Staphylococcus and streptococci) and may require drainage of an abscess; warm compresses are supportive. Definitive treatment to address the underlying obstruction is often lacrimal drainage surgery, most commonly dacryocystorhinostomy (external or endoscopic). In children, probing and silicone stenting may be employed. Chronic cases focus on resolving the obstruction to prevent recurrence.