Understanding Dacryocystitis (Tear Sac Infection)

Dacryocystitis almost always develops secondary to a structural or acquired blockage somewhere along the tear drainage pathway. Understanding the cause is important for selecting the right treatment.

• Primary Acquired Nasolacrimal Duct Obstruction (PANDO): The most common cause in adults. Progressive scarring and fibrosis of the nasolacrimal duct, often without an obvious precipitating cause, leads to complete obstruction and secondary infection.
• Dacryoliths (Tear Duct Stones): Calcified concretions can form within the lacrimal sac or duct, causing obstruction. These often produce episodes of acute dacryocystitis on a background of chronic tearing.
• Trauma and Previous Surgery: Facial fractures, nasal surgery, or previous sinus procedures can damage the nasolacrimal duct or lacrimal sac, leading to obstruction and infection.
• Nasal Pathology: Nasal polyps, deviated nasal septum, hypertrophied inferior turbinate, or chronic sinusitis can obstruct the drainage of the nasolacrimal duct into the nose.
• Congenital Obstruction (in Babies): In newborns and infants, dacryocystitis most commonly results from failure of the distal valve (Hasner's membrane) at the lower end of the nasolacrimal duct to open at birth. This affects up to 6% of newborns and usually resolves spontaneously or with massage and probing.

Home measures cannot cure dacryocystitis or resolve the underlying duct obstruction, but they can relieve symptoms and support medical treatment. Acute dacryocystitis with significant pain, swelling, or fever requires prompt medical attention and should not be managed with home remedies alone.

• Warm Compresses: Applying a warm, damp cloth to the inner corner of the eye several times daily can help relieve discomfort and promote drainage of accumulated secretions.
• Crigler Massage (for Babies): In infants with congenital nasolacrimal duct obstruction, a gentle downward massage over the lacrimal sac area (Crigler massage) applied several times daily helps build pressure to open the distal membrane and is the first-line management in the first year of life.
• Avoid Eye Rubbing: Rubbing the eye when it is infected can spread bacteria and worsen irritation. Gently clean away any discharge with a clean cotton pad.

Treatment of dacryocystitis targets both the active infection and the underlying obstruction. The two must both be addressed for lasting resolution.

Treatment of Acute Dacryocystitis

• Oral Antibiotics and Anti-inflammatory Medications: The first step in managing acute dacryocystitis. Common causative organisms include Staphylococcus aureus and Streptococcus species. Co-amoxiclav is frequently used, adjusted based on culture results.
• Intravenous Antibiotics: Required if the infection is severe, rapidly spreading, or associated with systemic fever and malaise. Hospitalisation may be necessary.
• Abscess Drainage: If a dacryocystocele (collection of pus) has formed, incision and drainage under local anaesthesia may be needed to decompress the abscess and hasten resolution.

Definitive Treatment of the Underlying Obstruction

• Probing and Syringing: Used for congenital nasolacrimal duct obstruction that has not resolved spontaneously by 12–18 months. A fine probe is passed through the tear drainage system to open the distal obstruction, followed by irrigation with saline.
• Dacryocystorhinostomy (DCR): The definitive surgical treatment for adults with recurrent or chronic dacryocystitis secondary to nasolacrimal duct obstruction. DCR creates a new bypass channel from the lacrimal sac directly into the nasal cavity, allowing tears to drain normally. This can be performed through an external skin incision or endoscopically (endonasally) without a visible scar.

After treatment for dacryocystitis, the following measures support recovery and reduce the risk of recurrence.

• Complete the Full Course of Antibiotics: Even if symptoms improve quickly, stopping antibiotics early risks relapse. Always complete the prescribed course.
• Attend Follow-up Appointments: Acute dacryocystitis that has been controlled with antibiotics will typically recur unless the underlying obstruction is treated. Follow up with your oculoplastic surgeon to plan definitive management.
• Seek Prompt Attention for Recurrence: Any recurrence of pain, swelling, or discharge near the inner corner of the eye should be evaluated promptly. Repeated infections can cause progressive scarring and make definitive surgery more complex.
• For Parents of Affected Infants: Consistently perform Crigler massage as directed by your eye specialist. Most congenital obstructions open by 12 months; if tearing and discharge persist beyond this age, probing is usually recommended.