Dacryocystitis (chronic)

Contents

Aetiology

As a result of infection, usually with Gram positive organisms, the lacrimal sac develops a mucocoele:

  • filled with mucoid material
  • can sometimes be expressed by applying pressure over the sac

Predisposing factors

Age over 30 years, female:male preponderance 2:1
History of recurrent or chronic unilateral conjunctivitis
Previous acute dacryocystitis
Chronic nasolacrimal duct obstruction
Facial fracture
Foreign bodies (e.g. punctal or canalicular plugs)

Symptoms of chronic dacryocystitis

One or more of the following:

  • recurrent episodes of epiphora, plus swelling, tenderness and redness at medial canthus
  • persistent redness at medial canthus
  • persistent painless swelling at or below the medial canthus
  • chronic epiphora

Signs of chronic dacryocystitis

Recurrent episodes similar to, but less severe than, acute dacryocystitis
Swelling at or below medial canthus
May be possible to express mucoid (opalescent) discharge by pressure over lacrimal sac

Differential diagnosis

Canaliculitis, sinusitis, sebaceous cyst, preseptal cellulitis, tumour or granulomatous lesion causing nasolacrimal obstruction (blood in tears may suggest this)
Dacryocystitis (acute)
(See also Clinical Management Guideline on Dacryocystitis (acute))

Management by optometrist

Practitioners should recognise their limitations and where necessary seek further advice or refer the patient elsewhere

GRADE* Level of evidence and strength of recommendation always relates to the statement(s) immediately above

Non pharmacological

In adults, it has been proposed that patients with lacrimal sac swelling and suspicion of obstruction of the lacrimal drainage system should be treated conservatively, reserving surgery for cases that do not respond. For symptomatic relief, advise traditional remedies such as hot compresses and massage
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Pharmacological

If infection suspected, give topical antibiotic (e.g. chloramphenicol drops or ointment) for not less than five days; also as a prophylactic measure while awaiting surgery
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
 

Management category

B2: alleviation/palliation (normally no referral)
B1: if symptoms recurrent and persistent, refer routinely

Possible management by ophthalmologist

Possible dacryocystography
Possible surgery: dacryocystorhinostomy (DCR)

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradingworkinggroup.org)
 

Sources of evidence

Coskun B, Ilgit E, Onal B, Konuk O, Erbas G. MR Dacryocystography in the Evaluation of Patients with Obstructive Epiphora Treated by Means of Interventional Radiologic Procedures. Am J Neuroradiol. 2012;33:141-7

Eshraghi B, Abdi P, Akbari M, Fard MA. Microbiologic spectrum of acute and chronic dacryocystitis. Int J Ophthalmol. 2014;7 (5): 864-7

Pinar-Sueiro S, Sota M, Lerchundi TX, Gibelalde A, Berasategui B, Vilar B, Hernandez JL. Dacryocystitis: Systematic Approach to Diagnosis and Therapy. Curr Infect Dis Rep. 2012;14(2):137-46

Summary

What is chronic Dacryocystitis?

Dacrocystitis means a low-grade inflammation of the tear sac, the small chamber in which the tear fluid collects as it drains from the eye surface, which is beneath the skin at the inner corner of the eye. It can result from a previous acute infection and from blockage of the tear duct leading from the tear sac to the inside of the nose. Finger pressure over the sac sometimes causes white mucus to appear at the openings of the tear passages at the inner corners of the eyelids; this may help in reaching a diagnosis. Patients usually complain of swelling and sometimes tenderness over the tear sac, plus watering of the eye.

How is chronic Dacryocystitis managed?

If the condition results in repeated episodes of acute infection, antibiotics are given, as eye drops. In less acute cases, hot compresses and massage over the tear sac may relieve the patient’s symptoms. A special test known as dacryocystography may help to show exactly where the tear duct blockage is, and this will help the eye surgeon to decide on whether surgery is necessary, and if so, of what kind. In a commonly performed operation known as a dacryocystorhinostomy or DCR, a new passage is created from the tear sac into the inner wall of the nose, so that the tears can drain directly without having to pass down the tear duct.

Dacryocystitis (chronic)
Version 14
Date of search 16.08.21
Date of revision 25.11.21
Date of publication 07.04.22
Date for review 15.08.23
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