Dacryocystitis

Tears are secreted naturally in our eyes in order to maintain the natural moisture for pain-free vision. Most tears are drained from the eyes but some excess tears are collected and transmitted via lacrimal sac into the nasal cavity.

The lacrimal sac is anatomically located at the inner corner of your eye and leads into the nasal passageways via lacrimal duct, a narrow tube that transfers the excess tears into the nasal cavity. Dacryocystitis takes place when you feel irritation and swelling in this sac, which will lead to dryness of eye with other disturbing symptoms. Dacryocystitis can also be a result of an infection.

The two types of Dacryocystitis are:-

  • Acute Dacryocystitis
  • Chronic Dacryocystitis
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Acute Dacryocystitis

The patient may complain of decreased visual acuity owing to the excess tears and an abnormal tear composition. Examination will reveal a tender, tense, red swelling (± preseptal cellulitis in severe cases). Mucopurulent discharge can be expressed from the punctum. There may be a fever and an elevated leukocyte count too.

Chronic Dacryocystitis

This may present with a history of chronic or recurring epiphora and may have persistent redness of the medial canthus. There may be a painless or recurring swelling over the lacrimal sac, and pressure over this will result in reflux of mucopurulent material through the lower punctum.

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Treatments of Dacryocistitis

 

The dacryocystitis treatment should be started as soon as you notice the symptoms. In case there are no symptoms of infection but your tear duct is blocked, your eye specialists may suggest these solutions:

  • Compress the surface with warm material
  • Massage the duct gently to drain in order to minimize the risk of infection

The most common and standard treatment for dacryocystitis is medicines, such as antibiotics. These pharmacological agents can help in reducing the symptoms and clearing up the infection. Most cases of acute dacryocystitis are easily treatable with the eye drops and antibiotic ointments, but you should be very careful when applying the ointments and must check whether they can be applied on eyes or not, otherwise you may develop other serious eye infections.

Minor surgical intervention may be required if antibiotics don’t work. Surgical intervention is a highly successful treatment for dacryocystitis. And actually, the results are 95% successful. Below are two kinds of surgeries that are commonly applied.

  • Balloon dacryoplasty. In this surgery, balloons are used to open the thin tear ducts. It is not successful as an endonasal approach and the success rate for complete obstructions is only 40.8% according to a recent clinical study. This approach is contraindicated in acute dacryocystitis, nasolacrimal duct posttraumatic obstruction and dacryocystolithiasis and is more suitable for patients having circumscribed crucial stenosis or nasolacrimal duct occlusions.
  • Endonasal approach with laser or without laser. It is more suitable for cases of chronic dacryocystitis. It helps in restoring the flow of tears into the nose from the lacrimal sac. During surgery, a hole is made in between the sac and the lacrimal fossa to restore the tear flow. After surgery, the tubes and drains are attached to cover the empty space and fill the gap. Below is video that explains the approach in detail.

 

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