Dacryocystitis (chronic)

Contents

Aetiology

Chronic dacryocystitis is an infection or inflammation of the lacrimal sac that occurs secondary to chronic obstruction of the nasolacrimal duct. There are several presentations:

  • recurrent episodes of conjunctival hyperaemia and epiphora
  • lacrimal sac mucocoele (dilation of lacrimal sac with mucoid fluid)
  • chronic conjunctivitis, with erythema of the lacrimal sac and possible reflux of purulent material with pressure

Predisposing factors

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

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
Erythematous 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

Chronic dacryocystitis is typically treated surgically. However, milder cases in adults could initially be treated conservatively

For symptomatic relief, advise traditional remedies such as warm 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: mild cases in adults, alleviation/palliation (normally no referral)
B1: if symptoms recurrent and persistent, refer routinely for possible surgery

Possible management by ophthalmologist

Possible dacryocystography
Probable surgery e.g. percutaneous or endoscopic 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?

Chronic dacrocystitis means a low-grade infection or 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 15
Date of search 01.11.23
Date of revision 21.12.23
Date of publication 05.03.24
Date for review 31.10.25
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