Dacryocystitis

Key Features

• Caused by nasolacrimal obstruction

• Acute and chronic dacryocystitis are typically caused by bacteria that colonize the upper respiratory tract, such as

  • Staphylococcus aureus

  • Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus viridans

  • Moraxella catarrhalis

  • Haemophilus species

Clinical Findings

• Acute dacryocystitis

  • Presents with inflammation, swelling, tenderness, and pain over the lacrimal sac (located inferior to the medial canthal tendon)

  • Fever may be present

  • Purulent discharge and tearing

• Chronic dacryocystitis

  • Mucopurulent debris on the lids and lashes

  • Tearing

  • Infection of the palpebral conjunctiva

  • Reflux of pus at the puncta when pressure is applied over the sac

Diagnosis

• Clinical

Treatment

• Severe acute dacryocystitis is treated with intravenous antibiotics after attempts at identifying the offending organism by culture and staining

• Oral antibiotics can be tried in milder cases

• Topical antibiotic administration is adjunctive and is also used with recurrent chronic infections

• Warm compresses are beneficial

• After the acute episode subsides—and in chronic cases—the nasolacrimal obstruction must be relieved surgically