Dacryocystitis: definition, symptoms, causes, diagnosis and treatment
Dacryocystitis is an inflammation of the lacrimal sac. It is a disease caused by a bacterial infection that usually results from an obstruction of the naso-lacrimal duct
Pathogens associated with this disease include Staphylococcus aureus and Streptococcus pneumoniae.
The symptoms are typical of inflammation with pain, oedema and redness, accompanied by excessive tearing.
Usually, if even slight pressure is exerted over the tear sac, purulent material escapes through the tear ducts.
This pathology presents certain complications including the formation of abscesses and fistulas of the tear ducts.
Treatment options include dacryocystorhinostomy and the use of oral antibiotics to counteract the obstruction of the naso-lacrimal duct.
Dacryocystitis: what is it?
Dacryocystitis is an inflammation affecting the lacrimal sac and is most often caused by a staphylococcal or streptococcal infection.
It is often the direct consequence of an obstruction of the naso-lacrimal duct, which is responsible for the drainage of excess tears into the eye.
The condition is caused by stenosis, i.e. narrowing, and occlusion of the tear ducts.
The stasis of tears over time causes irritation of the mucous membrane lining the lacrimal sac, also facilitating the spread of germs.
The condition affects patients of all ages, but is more common among children.
Congenital obstruction of the naso-lacrimal duct can occur in young children.
The disease can occur suddenly, in an acute form, or gradually, i.e. chronically.
Causes of dacryocystitis
Dacryocystitis is a condition usually caused by an infection that starts in the tear ducts.
Tearing is made possible by the presence of a system of ducts that originate in the inner lower corner of the eye.
They allow the drainage of excess tears that form in the eye and ensure its health.
The tears, once collected in the lacrimal sac, reach a small chamber located in the lateral wall of the nose.
From here they are channelled into the naso-lacrimal duct from where they then flow into the throat and nose.
At the origin of dacryocystitis is a narrowing or occlusion of the tear ducts.
If the tears cannot flow, they tend to accumulate in the tear sac, causing epiphora (excessive tearing) and inflammation.
Pathological stasis also increases the possibility of developing infections, making the eyes more prone to irritation.
Dacryocystitis can occur suddenly in its acute form or be chronic, i.e. with slower onset and longer duration
When the infection is acute, the area around the lacrimal sac is swollen, red and painful.
Applying light pressure to the area may cause purulent material to leak from the inner corner of the eyelids, known as tear ducts.
In severe cases, the inflammation may cause fever and pus formation on the skin surface when it opens outward in the form of a fistula.
Dacryocystitis has other symptoms such as sudden pain, redness and swelling of the area above the lacrimal sac, in the medial aspect of the lower eyelid and in the inner corner of the eye.
Patients also complain of excessive tearing, fever and secretion of pus and mucus from the eye.
As soon as symptoms are experienced, it is important to seek medical attention.
If the infection is not treated quickly and lasts for a long time, the healing process is much more difficult.
Chronic dacryocystitis, on the other hand, presents less severe symptoms, but which are prolonged over time, causing further narrowing of the naso-lacrimal duct.
Pain in this case is limited or absent, with the presence of epiphora and eye discharge.
While in its acute form dacryocystitis can be quickly resolved with antibiotic therapy, when it is chronic the condition can lead to serious consequences to the extent that surgery is necessary, especially in adults.
In infants born with tear duct obstruction, this condition is self-resolving in the first 9-12 months of life.
Diagnosis
Dacryocystitis is diagnosed with a simple examination in which the doctor assesses the presence of symptoms such as reddening of the inner corner of the eye, redness and excessive tearing.
In some patients, slight pressure on the lacrimal sac may cause pus or mucus to leak out.
The diagnosis can be confirmed by washing the tear ducts to check whether there is a partial or complete obstruction of the ducts.
A fluorescein dye is applied to the inner corner of the eye.
If the tear drainage system is functioning, the dye will disappear from the eye after a few minutes.
The doctor can then assess the reflux by pressing on the tear ducts and examining the resistance.
Other recommended tests include dacryocystography and CT scans of the orbit and paranasal sinuses, which are useful if structural abnormalities are suspected.
Risk factors
Dacryocystitis is associated with obstruction of the naso-lacrimal duct.
There are certain factors that may increase the possibility of developing this condition.
For example, those with stenosis due to growth of the surrounding tissue are most at risk, as are patients who have suffered injury or trauma to the eye and adjacent tissues, those suffering from infection, neoplasia or inflammation.
Other risk factors are nasal diseases, such as nasal septum deviation, rhinitis, nasal polyps, sinusitis and hypertrophy of the nasal turbinates.
Dacryocystitis is more frequent in those who have undergone nasal or sinus surgery and in the presence of dacryoliths.
These yellowish-white formations can lead to mechanical obstruction in the lacrimal drainage system at various levels.
The condition is more frequent in children where it can occur due to a congenital obstruction of the naso-lacrimal duct, called dacrocistocele.
Dacryocystitis: complications
Dacryocystitis is a condition that must be dealt with decisively and quickly. Otherwise, it can lead to numerous complications.
If the infection is not treated, it can spread both superficially and deeply, leading to abscess, meningitis or sepsis.
These complications are rare, but possible, especially in immunocompromised patients.
How is dacryocystitis treated?
Once a diagnosis of dacryocystitis has been made, an effective treatment can be set up.
The doctor usually recommends warm compresses with a damp cloth to be applied to the affected area.
Massage in the region of the lacrimal sac may be helpful to promote drainage.
If an infection of the tear duct is present, antibiotic treatment taken orally is prescribed.
Medication is particularly useful in cases of chronic dacryocystitis to relieve symptoms and quickly counteract acute infections.
If the condition does not respond to antibiotic treatment and is recurrent, surgery may be required.
The most commonly performed operations are naso-lacrimal duct probing and dacryocystorhinostomy.
In the former case, a thin wire is introduced into the naso-lacrimal duct to remove any blockage.
This treatment is especially recommended for infections affecting newborns.
A dacryocystorhinostomy, on the other hand, consists of an expansion of the blocked or narrowed naso-lacrimal duct.
In order to prevent the infection from recurring, it is expanded with a procedure that involves the formation of a drainage passage between the nasal mucosa and the lacrimal sac to prevent a build-up of pus and to facilitate the outflow of tears.
Dacryocystitis: a pathology of the lacrimal apparatus
Dacryocystitis is a pathology affecting the lacrimal apparatus.
Tears are liquid secretions that coat the conjunctival surfaces and are intended to keep them protected and moist at all times.
They reduce friction, provide oxygen and nourishment to the conjunctival epithelium and hinder the action of bacteria.
Tears are also a barrier against toxic substances and small foreign bodies.
Their action is enhanced by the eyelids, whose intermittent movements distribute the tears over the surface of the eye, keeping it lubricated at all times.
The lacrimal apparatus consists of the lacrimal gland, the lacrimal ducts, the lacrimal sac and the nasolacrimal duct.
Tears are produced by the lacrimal glands, which are located in the conjunctiva.
To these is added an oily component that is supplied by the meibomian glands.
The tears, through a system of tear ducts, are collected in the lacrimal sac
They flow into the nasolacrimal duct and outflow on their way to the throat and nose.
In the meantime, the process resumes and new tears are produced.
Tear disorders are caused by alterations in the tear distribution and outflow process.
Causes can be increased secretion by the lacrimal gland (hyperlachrymation) or insufficient drainage of the tear ducts (epiphora).
The tear film can be altered by diseases affecting the ocular structures or it can be a symptom of a systemic disease, e.g. Sjögren’s syndrome.
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