One of the conditions that brings patients to the eye clinic with significant discomfort and a great deal of worry is a swollen, tender lump at the inner corner of the eye. Adding to the concern is the fact that most people have never heard the term dacryocystitis before. We see this as a foreign term, which in turn causes anxiety.
Dacryocystitis is an infection of the lacrimal sac, the small organ that collects tears that we have between the eye and nose. It is a treatable condition and in the main does very well when managed early and properly. In this guide, we will discuss what causes it, how to recognize it, and what the treatment options are like based on stage and severity.
What Is Dacryocystitis?
Understanding how the tear drainage system works is the first step in understanding dacryocystitis. The tear glands produce tears, which are spread across the surface of the eye with each blink. The tears then enter tiny openings at the edges of the eyelids, marking the beginning of their journey through the tear drainage system and out of the body.
They go through a narrow passageway into the lacrimal sac and from there into the nose via the nasolacrimal duct. Sometimes, the nasolacrimal duct becomes blocked in which case the tears and mucus don’t leave as they should. They collect in the lacrimal sac, which at the same time provides a warm and still environment in which bacteria can breed and multiply. This leads to the development of dacryocystitis.
There are two types. In acute dacryocystitis, the issue comes on very fast, usually with intense pain, swelling, and redness. In chronic dacryocystitis, the issue is a long-term one which results in continuous weeping, discharge and a lump at the inner eye corner but the pain is not as acute as in the sudden form.
What Causes Dacryocystitis?
The underlying problem in almost all cases of dacryocystitis is a blocked nasolacrimal duct. What causes that blockage varies by age and individual circumstances.
| Cause group | How Does It Lead to Dacryocystitis? |
| Congenital nasolacrimal duct obstruction | In newborns and infants, the duct sometimes fails to open fully at birth. Persistent watering and discharge in early months may lead to lacrimal sac infection if not managed. |
| Age-related narrowing | In adults, especially older women, the duct can gradually narrow due to inflammation, bony changes in the nasal passage, or prior nasal or sinus surgery. |
| Nasal or sinus conditions | Chronic sinusitis, nasal polyps, or a deviated nasal septum can compress or block the lower end of the duct where it drains into the nose. |
| Trauma or previous surgery | Injury to the facial bones around the nose or prior surgery in the lacrimal region can cause scarring and blockage. |
| Inflammatory conditions | Conditions like sarcoidosis or granulomatous diseases can occasionally affect the lacrimal drainage system. |
| Stones (dacryoliths) | Inspissated secretions can occasionally form small stones in the sac that block drainage. |
Once the duct is blocked and stagnant material accumulates, common bacteria such as Staphylococcus aureus, Streptococcus species, and Haemophilus species are the usual causes of the resulting infection.
Dacryocystitis Symptoms to Watch Out for
The symptoms of dacryocystitis differ somewhat between the acute and chronic forms, but the common thread is a problem near the inner corner of the eye.
| Symptom | Acute dacryocystitis | Chronic dacryocystitis |
| Pain and tenderness | Significant; the area is very tender to the touch. | Mild or absent |
| Swelling and redness | Prominent red, warm swelling below the inner corner of the eye | Soft lump with minimal inflammation. |
| Discharge | Pus may discharge through the punctum when the sac is pressed | Mucoid or watery discharge, particularly on waking |
| Watering eye (epiphora) | Present | Often persistent and the main complaint |
| Fever and general illness | Can occur in severe acute cases | Usually absent |
| Fistula formation | In untreated or recurrent cases, a sinus may open through the skin | Can occur in longstanding cases |
If you notice a painful, red swelling near the inner corner of your eye that is getting worse rather than better, that is a sign to seek care at an eye hospital promptly rather than waiting.
How Is Dacryocystitis Diagnosed?
Dacryocystitis is primarily a clinical diagnosis, which means your ophthalmologist will usually be able to identify it from the history and exam alone. The tell-tale location of the tenderness and swelling, the discharge pattern, and the history of epiphora all point to the lacrimal sac.
To confirm the diagnosis and assist with treatment planning, your doctor may also perform the following:
- Press lightly over the lacrimal sac and note whether there may be pus or mucus that returns through the tear duct which is a key indicator.
- Schedule a trial of irrigation to see which ducts are blocked and at what point, typically after the acute phase has passed.
- In complex cases, at the time of recurrent presentations, or when we need to rule out a structural issue or tumor, we request a CT scan or dacryocystography.
- Take a sample of the discharge that is present to identify which bacteria are present and thus which antibiotic to use.
- This study helps to tell which is a simple infection and which is an abscess, a fistula, or a base structural issue that requires more than just antibiotics.
Dacryocystitis Treatment: Medical and Surgical Options
Treatment depends on whether the presentation is acute or chronic, and whether the underlying duct blockage can be resolved or must be bypassed surgically.
Acute Dacryocystitis Treatment
In the early stages, the primary goal is to control the infection and inflammation. Oral antibiotics are the mainstay of treatment. Your doctor will prescribe an antibiotic that covers the most common bacteria that cause lacrimal sac infection and may change that choice once culture results are in.
In severe cases with high temperature, large swelling or signs of the infection spreading (orbital cellulitis), hospital admission and intravenous antibiotics may be required. Warm compresses applied gently over the affected area several times a day can improve local circulation and encourage drainage.
Topical antibiotic drops may also be added to the eye treatment regimen. If an abscess does form a fluctuant and pointed swelling of collected pus it may need to be drained by a surgeon. Although spontaneous drainage through the skin may occur, it can leave a scar. Surgical drainage in a controlled setting generally provides a better outcome.
The critical point is that antibiotics treat the infection but do not resolve the underlying duct blockage. Without addressing the blockage, dacryocystitis is very likely to recur.
Chronic Dacryocystitis Treatment
Chronic dacryocystitis, or recurrent acute attacks, requires a definitive solution to the blocked duct. In adults, this usually means surgery.
Dacryocystorhinostomy (DCR) is the standard surgical procedure for chronic duct blockage. The surgeon creates a new drainage pathway that goes directly from the lacrimal sac to the nasal cavity, thereby bypassing the blockage.
This may be done via an external approach (external DCR) or through the nose with the use of an endoscope (endonasal or endoscopic DCR) depending on the patient’s anatomy and the surgeon’s preference.
Both methods have high success rates at specialist eye hospitals. Endoscopic DCR has the benefit of no external scarring and a quicker recovery for many patients. External DCR is still the method of choice in complex or revision cases.
| Surgical approach | Access route | Typical use |
| External DCR | Small incision on the skin near the inner corner of the eye | Primary cases, complex anatomy, revision surgery, cases with lacrimal sac pathology |
| Endoscopic (endonasal) DCR | Through the nasal passage using a fine camera | Primary cases with suitable anatomy; preferred where cosmetic outcome matters |
A silicone tube (stent) is often placed through the new passage during surgery to keep it open while healing occurs. This is removed in the clinic a few weeks to months later as directed by your surgeon.
Treatment in Infants and Young Children
In newborns who present with congenital nasolacrimal duct obstruction, the first line of management is conservative. In most cases, resolution is seen within the first year of life with the help of regular massaging of the lacrimal sac and the use of antibiotic drops at the time of active discharge. Should the obstruction persist beyond 12 months, we perform probing of the duct under general anaesthesia. This is a short procedure that has a very high success rate and is the standard first surgical step in this age group.
Eye Care at Vasan Eye Care
Dacryocystitis is within the scope of oculoplasty services at Vasan Eye Care. We evaluate patients who present with watering eyes, recurrent discharge, or lacrimal sac swelling, in which we do a full clinical exam and may do some investigations before we determine a treatment plan.
We perform both external and endoscopic DCR procedures which are done by our staff of experienced oculoplastic surgeons that individualize treatment based on the patient’s anatomy, past health issues, and what the patient prefers. We provide postoperative care and follow-up to see that the new drainage passage does indeed heal properly and function in the long term. We also offer a full range of eye care services for related conditions like chronic conjunctivitis, dry eye and lid issues all in the same place.
Key Takeaways
- Dacryocystitis is an infection of the lacrimal sac that usually results from blockage of the nasolacrimal duct.
- Acute episodes are treated with antibiotics and warm compresses. Abscess formation may need surgical drainage.
- Abscess formation may require surgical drainage. The cause of the duct blockage must be resolved to prevent recurrence.
- DCR surgery, whether external or endoscopic, creates a new drainage pathway and has high long-term success rates.
- Early evaluation at a qualified eye hospital is important to prevent complications like orbital cellulitis, fistula formation, or recurrent infections.
Frequently Asked Questions
Dacryocystitis is an infection of the lacrimal sac, the little pocket which collects tears which in turn drain into the nose. It is characterized by pain, redness, and swelling at the inner eye corner also often with discharge. It is a true infection which does require proper treatment, but is in fact not a life-threatening condition for the most part. With prompt antibiotic treatment and in some cases also surgery we see very good results in the great majority of patients.
Mild early cases may see some improvement but dacryocystitis does not reliably go away without treatment. The blockage in the duct which causes it remains and we see the infection coming back. If left untreated or only partially treated, dacryocystitis can progress to abscess formation, spread to surrounding tissues (orbital cellulitis), or lead to the development of a skin fistula. We should use medical treatment that is followed by surgical correction of the blockage as required.
During acute episodes, oral antibiotics are the mainstay of treatment, often combined with warm compresses and topical antibiotic drops. In case of chronic or recurrent dacryocystitis in adults we have DCR, which is what creates a new tear drain into the nose. We have that as a proven definitive solution. Also we see that results from DCR which is performed by experienced surgeons at an eye specialist hospital, are very good and we do not see high recurrence rates after successful surgery.
Prevention can be difficult because the underlying cause is often the gradual development of duct obstruction related to age, anatomy, or previous nasal disease. But if we catch the issue early like in cases of watery eyes and recurring discharge before they turn into a established infection early treatment of nasal and sinus issues, and close follow-up after facial or tear duct surgery we may be able to reduce the chance of getting dacryocystitis which may be either a recurrence or a new case. Any persistent watery eye in an adult or an ongoing discharge in an infant should be evaluated at an eye hospital instead of being left untreated.
References
- Cleveland Clinic – Dacryocystitis
https://my.clevelandclinic.org/health/diseases/24419-dacryocystitis - National Institute of Health
https://www.ncbi.nlm.nih.gov/books/NBK470565/