What Is the Lacrimal Sac?
The lacrimal glands produce tears, which are needed to hydrate the eyes to keep them clean and free from bacteria. These tears spread throughout and hydrate the eyes when the eyes are linked. Below the upper eyelids, the lacrimal glands are present. Tears produced in these glands are released through the small openings in the front of the eye. The tears are drained through the lacrimal sac or tear sac present in the inner corner of the eye near the nasal bridge. The upper part of the nasolacrimal duct is dilated, called the lacrimal sac.
What Is Dacryocystitis?
When the lacrimal or tear sac is inflamed, it results in dacryocystitis. Any obstruction in the lacrimal duct leads to stagnation of the tears in the lacrimal sac. This causes the bacteria to build inside the lacrimal sac and produces an infection.
What Are the Types of Dacryocystitis?
Depending on the duration of symptoms, dacryocystitis is divided into:
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Acute Dacryocystitis - The onset of symptoms is gradual, and systemic antibiotic therapy is needed for managing this type of dacryocystitis.
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Chronic Dacryocystitis - Chronic inflammation of the lacrimal sac due to infections, inflammatory debris, and systemic diseases.
Depending on the cause, dacryocystitis is divided into:
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Congenital Dacryocystitis: A misnomer that refers to dacryocystitis that develops after birth and not at birth. The cause is an infection of the conjunctival sac due to retained excretions rather than inflammation
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Acquired Dacryocystitis: Acquired dacryocystitis occurs after the first year of life and is caused due to trauma or infection of lacrimal drainage pathways, resulting in obstruction.
How Prevalent Is Dacryocystitis?
Dacryocystitis has a gender predisposition and is more common in females. Caucasians are commonly affected as compared to Americans and Africans. About 6 percent of newborns are affected by dacryocystitis since birth. When it is an acquired condition, it is widely prevalent in individuals above 40 years.
What Is the Pathophysiology of Dacryocystitis?
Obstruction of the nasolacrimal duct is an essential characteristic feature that precedes dacryocystitis. As a result of obstruction, lacrimal fluid stagnation is produced inside the lacrimal sac. This creates a suitable environment for the growth of microorganisms, which infects the lacrimal sac bringing about erythema and edema.
What Causes Dacryocystitis?
Dacryocystitis occurs in infants and adults due to the most common cause, blockage of the tear duct. In infants, it occurs due to congenital abnormalities, and in adults, the following acquired factors bring about dacryocystitis:
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An injury involving the eyes or nose.
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Nasal polyps, which are nasal growths.
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Presence of foreign objects in the lacrimal duct that blocks the passage.
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Any surgery to the nose or sinus.
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Cancer involving the nasal or sinus passages.
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Infections of the nose or sinus are caused by Staphylococcus or Streptococcus bacteria.
How Is Dacryocystitis Manifested?
The intensity of the disease varies from one individual to another. Also, it is dependent on the type of dacryocystitis.
The following are the symptoms of dacryocystitis:
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The pain usually involves the lower outer corner of the eyelid.
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The lower eyelid on its outer surface also exhibits redness and swelling.
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Excessive tears.
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A thick or pus discharge from the eyes.
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Fever.
Although these are the symptoms seen in acute and chronic dacryocystitis, the intensity of these symptoms is different in both cases. Acute dacryocystitis exhibits more intense symptoms, while in the case of chronic dacryocystitis, the symptoms are less severe. Meanwhile, pain, redness, and swelling are comparatively reduced in chronic dacryocystitis.
What Increases the Risk of Developing Dacryocystitis?
Since dacryocystitis is most commonly caused by blockage of the lacrimal duct, risk factors for lacrimal duct blockage increase the risk of developing it.
The following are the risk factors for developing dacryocystitis:
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Older adults.
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Using topical eye medications and anti-glaucoma medications.
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Chronic inflammation of the eyes like conjunctivitis.
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Surgery involving the eyes, nose, and sinus.
How Can We Diagnose Dacryocystitis?
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Medical history and physical examination by a physician help in diagnosing dacryocystitis. The symptom of swelling and redness in the eyes is a crucial diagnostic feature of dacryocystitis.
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Dye Disappearance Test: When the yellow dye is placed in the eye corner, the dye stays in the eye for a longer time, while in the case of a normal eye, the dye readily disappears. This is because of the blockage in the tear ducts. This test helps in determining the extent of blockage, partial or complete, by inserting a swab into the nose with suspected blockage. When there is dye present inside the nose, it indicates partial blockage.
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When there is pus formation, pressing the lacrimal sac causes the pus to come out, which is collected and tested for the presence of bacteria.
How Is Dacryocystitis Treated?
Treatment for dacryocystitis depends on the type and the underlying cause. In the case of congenital dacryocystitis, the symptoms usually resolve in a year and do not require treatment.
1. Medications:
In acute dacryocystitis, antibiotics are the primary treatment. Both oral and intravenous antibiotics are needed, depending on the situation. When the infection is mild to moderate, oral antibiotics provide immediate relief from the condition. If the symptoms of dacryocystitis worsen due to severe infection or the development of orbital cellulitis, systemic administration of antibiotics is needed.
2. Surgery:
Surgical treatment for dacryocystitis is recommended in the case of chronic conditions. The following are the surgical procedures involved in the treatment of dacryocystitis:
- Balloon Dacryoplasty: In this procedure, a thin catheter is inserted into the lacrimal duct through the nose, and blown several times after it reaches the blockage. Thus, opening the blockage.
- Nasolacrimal Probing: When there is an obstruction in the lower part of the nasolacrimal duct, this surgical procedure is adopted and has a success rate of 70 percent. A probe passed through the lacrimal sac reaches the lower end of the nasolacrimal duct to open the obstruction.
- Dacryocystorhinostomy: It is a surgical procedure in which a new pathway is created to bypass the blockage so that the tears are drained normally.
- Nasolacrimal Stenting: A stent is placed into the nose through the puncta, which helps prevent blockage, thereby enabling drainage of tears.
What Home Remedies Help in Relieving the Symptoms of Dacryocystitis?
1. Warm Compression:
Warm compression relieves pain caused by dacryocystitis and makes Crigler massage more effective. After wetting the washcloth in warm water, clean the pus from the eyes by gently wiping them. Keep the washcloth over the eyes for five minutes.
2. Crigler Massage:
Once the warm compress is removed, place the index finger on the corner of the eyes and gently press it. Pus or fluids may be seen coming out from the eye. Wipe it with a clean cloth. Do not forget to wash the hands after doing this.
What Are the Complications of Dacryocystitis?
The following are the life-threatening complications associated with dacryocystitis when treatment is not sought at the right time:
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Brain abscess (pus gets collected in the brain).
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Sepsis (inflammatory response to infection that affects the entire body).
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Meningitis (inflammation of the membranes involving the brain and spinal cord).
Conclusion:
Dacryocystitis is a condition that is best treated in its acute forms with the help of antibiotics. While in the case of chronic disease, surgical options are the most recommended to clear the blockages. When one experiences symptoms of dacryocystitis, it is needed to reach out to an ophthalmologist at the earliest to get adequate treatment.
