Dacryocystitis (chronic)

The CMGs are guidelines on the diagnosis and management of a range of common and rare, but important, eye conditions that present with varying frequency in primary and first contact care.

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Aetiology

Lacrimal sac develops a mucocoele:

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

Predisposing factors

  • 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

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

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

Differential diagnosis

Canaliculitis, sinusitis, sebaceous cyst, preseptal cellulitis, tumour or granulomatous lesion causing nasolacrimal obstruction (blood in tears may suggest this)

(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 refractory to these techniques
  • 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. gutt. or oc. chloramphenicol) 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

  • Arrange dacryocystogram (DCG: X-ray with contrast medium)
  • Possible surgery: dacryocystorhinostomy (DCR)

Evidence base

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

Sources of evidence

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

Lay summary

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.

If the condition results in repeated episodes of acute infection, antibiotics are given, both as eye drops and as medicines to be taken by mouth. In less acute cases, hot compresses and massage over the tear sac may relieve the patient’s symptoms. A special X-ray known as a dacrycystogram or DCG 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 12
Date of search 17.07.17
Date of revision 19.12.17
Date of publication 06.04.18
Date for review 16.07.19
© College of Optometrists 

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