Dacryocystitis is an infection of the tear sac (lacrimal sac) in the inner corner of your eye. Tears drain through this sac as they leave your eyes. Tears help keep your eyes hydrated, clean, and free of bacteria. The lacrimal glands underneath your upper eyelids produce tears, which travel through small openings to the front of your eye. Every time you blink, the tears spread across your eyes. To make room for new tears, the fluid drains out of your eyes through small holes, called puncta, in the corners of your upper and lower eyelids. Then it drains through the nasolacrimal sac into the tear duct (lacrimal duct) and into the back of your nose. Infections are usually caused by a blockage in the lacrimal duct that allows bacteria to build up inside the tear sac. An infection that starts suddenly is called acute dacryocystitis. An infection that lasts for a long period of time is called chronic dacryocystitis.
Symptoms
Symptoms of acute dacryocystitis include:
- pain, redness, and swelling in the inner corner of the eye
- watery eye
- swelling in the corner of the eye next to the nose
- eye redness
- pus or mucus in the corner of the eye
- fever
Symptoms of chronic dacryocystitis are usually milder. You may notice tearing and some discharge from your eye, but little to no swelling. Your doctor will diagnose you based on your symptoms and an examination of your eye. Sometimes, imaging tests like CT scans are done to help the doctor look for the cause of the blockage.
Treatment
The main treatment for dacryocystitis is antibiotics. These drugs kill the bacteria that caused the infection. Usually you take antibiotics by mouth, but if you have a severe infection, you may get them through an IV. Your doctor might also prescribe antibiotic eye drops or ointment. To relieve pain and swelling from the infection, hold warm compresses to your eye a few times per day. After the infection clears, you may need a procedure called dacryocystorhinostomy (DCR). This surgery bypasses the blocked duct, usually by removing a nearby bone. It allows tears to drain directly from the lacrimal sac into the nose. Widening the duct prevents you from getting infections in the future. The surgery may be done endoscopically through very small incisions.
Causes
The infection usually starts because of a blockage in the tear duct. Possible causes of this blockage include:
- injury to the nose or eye, such as a broken nose
- growths inside the nose called nasal polyps
- sinus inflammation
- nasal or sinus surgery
- foreign object in the duct
- cancer
Dacryocystitis is most common in babies, who can be born with a blockage of the tear duct. This is called congenital dacryocystitis. Middle-aged women are more likely than men to have a blockage because their duct is naturally narrower. The condition becomes more common as you age.
Other risk factors for dacryocystitis include:
- deviated septum, when your septum (the thin wall between your nostrils) is off-center, making one nostril smaller than the other
- rhinitis, or inflammation of the mucous membrane in the nose
- inferior turbinate hypertrophy, or swelling of one of the bony structures in your nose that help filter and humidify the air you breathe
Prevention
You can prevent future infections by having surgery called dacryocystorhinostomy to widen the blocked duct. If you or your child often gets tear duct infections, one way to prevent them is to drain the tear sac. Wash your hands, then hold a warm, wet washcloth over the tear sac. Carefully place your finger in the corner of your eye near your nose and apply pressure to the tear sac. Fluid or pus should release from the sac. Afterward, hold the warm compress to your eye again.
Complications
An acute infection can become chronic if you don’t treat it quickly enough. In babies with congenital dacryocystitis, the infection can spread into the eye socket. This can lead to life-threatening complications such as:
- brain abscess, a collection of pus in the brain
- meningitis, or inflammation of the membranes around the brain and spinal cord
- sepsis, a body-wide inflammatory response caused by infection
Outlook
Acute dacryocystitis will usually improve quickly with antibiotics. Babies with the congenital form of the condition often grow out of it by age 1 because the tear duct widens as they age. Chronic lacrimal infections can be hard to treat. You might need surgery to widen the tear duct drainage channel.