Dacryocystitis: Symptoms, Causes and Treatment
Dacryocystitis is inflammation, usually caused by infection, of the lacrimal sac. It commonly produces pain, redness, and swelling near the inner corner of the eye, close to the nose, and may be accompanied by excessive tearing or discharge.
It often develops because the tear drainage system is blocked and tears cannot drain normally.
What causes dacryocystitis?
Tears leave the eye through small openings in the eyelids and travel into the lacrimal sac before draining into the nose.
When this pathway becomes obstructed, tears and secretions may collect inside the lacrimal sac, creating an environment where bacteria can grow.
In adults, obstruction may be associated with:
Anatomical changes in the tear drainage system
Chronic inflammation
Previous trauma or surgery
Nasal or sinus disease
Abnormalities involving nearby tissues
Some patients experience persistent tearing for months or years before an infection develops.
In newborns, the problem is usually caused by congenital nasolacrimal duct obstruction. This may cause tearing and discharge during the first weeks of life.
What are the symptoms?
Acute dacryocystitis commonly causes:
Pain and tenderness near the side of the nose
Redness and swelling at the inner corner of the eye
Excessive tearing
Discharge
A feeling of pressure or discomfort
Chronic cases may mainly produce persistent tearing, recurrent discharge, or repeated episodes of conjunctivitis.
A blocked tear duct may remain as the underlying problem even after the infection improves.
When does it require urgent evaluation?
Same-day medical evaluation is recommended when symptoms include:
Fever
Severe pain
Rapidly increasing swelling
Blurred or decreased vision
Difficulty moving the eye
Swelling extending into the eyelids or cheek
Feeling generally unwell
These findings may indicate that the infection is spreading into surrounding tissues.
Early evaluation is also advisable in patients with diabetes, immunosuppression, or recent surgery or trauma involving the eye or nasal area.
How is dacryocystitis diagnosed?
Diagnosis usually begins with a complete eye examination.
The evaluation may include examination of:
The eyelids
Tear drainage openings
Lacrimal sac
Ocular surface
Presence of discharge
Previous episodes of tearing or infection
Once an acute infection has been controlled, additional testing may be performed to determine whether the tear drainage system remains blocked and where the obstruction is located.
Depending on the case, this may include irrigation of the tear drainage system or imaging studies.
Not every red or discharging eye is caused by dacryocystitis. Conjunctivitis, a stye, or an infection of the tissues around the eye can produce similar symptoms and require different treatment.
How is dacryocystitis treated?
During an acute infection, the first goal is to control the infection.
Depending on severity, treatment may include:
Oral antibiotics
Intravenous antibiotics in more severe cases
Local measures for symptom relief
Close follow-up
Eye drops alone are not always sufficient because the infection is located within the lacrimal sac rather than only on the surface of the eye.
Self-treatment with leftover antibiotics or steroid eye drops is not recommended.
What happens after the infection is controlled?
Once the acute episode has improved, it is important to determine whether the tear drainage system remains obstructed.
If the blockage persists, tearing, discharge, and infections may return.
In adults with significant nasolacrimal duct obstruction, definitive treatment often involves a dacryocystorhinostomy (DCR).
This surgery creates a new drainage pathway between the lacrimal sac and the nasal cavity so that tears can drain normally again.
Depending on the anatomy and type of obstruction, the procedure may be performed through a small skin incision or through an endoscopic nasal approach. A temporary silicone tube may also be placed during healing.
What about babies?
Congenital tear duct obstruction is managed differently.
Many cases improve spontaneously during the first months of life and may initially be treated with measures recommended by the ophthalmologist, including lacrimal sac massage.
If the obstruction persists or causes recurrent infections, probing of the tear drainage system may be recommended.
What should be avoided?
When painful swelling is present over the lacrimal sac, patients should avoid:
Squeezing or forcefully pressing the area
Aggressive massage during an acute infection
Using medications or eye drops without medical advice
Delaying evaluation if symptoms are worsening
Effective treatment involves more than controlling the infection. It is also important to determine whether an underlying obstruction is responsible for recurrent episodes.
In Dr. Andrés Lozano’s practice, evaluation of the tear drainage system integrates diagnosis, treatment of infection, and, when necessary, correction of the underlying obstruction to restore normal tear drainage.
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