Generality
Dacryocystitis is an "inflammation of the lacrimal sac.
The inflammatory process causes pain, redness, tissue edema and excessive tearing. In addition, digital pressure exerted over the lacrimal sac can push purulent material out through the tear punctures. The most common complication is corneal ulceration.
Therapeutic management of dacryocystitis involves oral antibiotics, warm compresses, and dacryocystorhinostomy to repair the nasolacrimal duct obstruction.
Causes
Dacryocystitis is usually caused by an "infection that begins in the tear ducts.
Dacryocystitis is caused by narrowing or occlusion of the tear ducts. If the tears are unable to drain, they accumulate in the lacrimal sac, thus causing inflammation and excessive tearing of the eye (epiphora).
Pathological stasis of tear fluid in the drainage system increases the risk of infection and makes the eyes more vulnerable to irritation.
Risk factors
Dacryocystitis is almost always associated with a "nasolacrimal duct obstruction."
Factors that can increase the risk of developing the condition include:
- Stenosis for the growth of the surrounding tissue;
- Injury or trauma to the eye or adjacent tissues, infections, inflammation and neoplasms;
- Nasal disorders: deviation of the nasal septum, sinusitis, rhinitis, nasal polyps and hypertrophy of the nasal turbinates;
- Nasal or sinus surgery
- Presence of dacryolites (yellowish-white limestone formations) at various levels of the tear drainage system, which cause mechanical obstruction.
Dacryocystitis can occur at any age, but it tends to be more common in children. These, in fact, can also present a "congenital obstruction of the nasolacrimal duct (defect referred to as dacrocystocele).
Symptoms
For further information: Dacryocystitis Symptoms
Dacryocystitis can occur suddenly (acute) or be long-lasting (chronic). In chronic cases, tearing may be the only noticeable symptom. In acute infection, the area around the lacrimal sac is painful, red and swollen. Also, light pressure applied to the area can push purulent material out through the opening of the tear canals, into the inner corner of the eyelids (tear dots).
Sometimes, a severe infection can cause fever and collection of pus, which can also discharge on the skin surface by forming a fistula, which usually closes after a few days of drainage.
Typical symptoms of acute dacryocystitis include:
- Inflammation: sudden onset of pain, redness and swelling in the area above the lacrimal sac, at the level of the medial canthus of the lower eyelid, in the inner corner of the eye;
- Excessive tearing
- Secretions of mucus or pus from the eye;
- Fever.
If a nasolacrimal duct infection is not treated quickly or if it causes minor symptoms that build up over a long period, it can be more difficult to treat. Chronic dacryocystitis, in fact, has less severe symptoms, but, over time, it can induce a further narrowing up to the occlusion of the lacrimal ducts. Although epiphora and eye discharge may be present, pain is usually limited or absent, as are redness and edema.
Acute infections typically resolve quickly with antibiotic therapy, while chronic infections, especially in adults, can be difficult to cure without surgery.
In infants, tear duct obstruction is commonly self-resolving and clears at the age of 9-12 months.
Complications
The risks associated with untreated dacryocystitis mainly include the risk of spreading the infection superficially (cellulitis), deep (orbital cellulitis, abscess or meningitis) or generalized (sepsis). These complications are rare and occur mainly in immunocompromised individuals.
Diagnosis of dacryocystitis
The doctor evaluates the presence of clinical signs that characterize dacryocystitis: swelling and redness in the inner corner of the eye, fever and excessive tearing. Pressure on the lacrimal sac can cause mucus or pus to escape. If purulent discharge is present, a sample may be taken and analyzed to determine which organism is causing the infection.
To confirm the diagnosis of dacryocystitis, the doctor may subject the patient to washing the lacrimal ducts, which allows to check the presence of a "complete or partial obstruction of the involved channels. A fluorescein-based dye is placed in the" inner corner of the " eye, so that it can merge with the tear film. If the tear drainage system is functioning properly, the dye should disappear from the surface of the eye after a few minutes.
The doctor can examine the punctal reflux by pressing on the tear channels and note any resistance. If structural abnormalities are suspected, a dacryocystography and a CT scan of the orbit and paranasal sinuses can also be done.
Treatment
If a "tear duct obstruction is confirmed, in the absence of signs of infection, the doctor may recommend:
- Warm compresses on the area (with a damp cloth);
- Gentle massages to the lacrimal sac region to promote drainage.
For overt tear duct infection, standard treatment is antibiotic therapy, which can be taken by mouth. These drugs can resolve acute infections quickly and relieve the symptoms of chronic dacryocystitis. However, if the dacryocystitis does not respond to antibiotics and tends to recur, surgery may be required. Generally, the prognosis associated with surgery is good.
Several types of surgical treatments can be applied to dacryocystitis:
- Probing of the nasolacrimal duct, in which a thin wire is guided through the nasolacrimal duct to remove any blockages. This is the most common treatment for recurrent infections in infants.
- In dacryocystorhinostomy, the narrowed or obstructed nasolacrimal duct is expanded to prevent the infection from recurring. The procedure usually involves creating a drainage passage between the lacrimal sac and the nasal mucosa of the middle meatus to prevent the accumulation of purulent material and allow the outflow of tears.
