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Dacryocystitis is also known as blocked tear duct. Dacryocystitis is an infection in the tear duct/sac – a passage canal which connects the eye to the nasal cavity inside the facial bone. The inflammation is due to an obstruction in the duct when the flow of the tears in the lacrimal sac is affected.
Dacryocystitis is also known as blocked tear duct. Dacryocystitis is an infection in the tear duct/sac – a passage canal which connects the eye to the nasal cavity inside the facial bone. The inflammation is due to an obstruction in the duct when the flow of the tears in the lacrimal sac is affected. As a result, there is an accumulation of mucus secretions and layers of cell build up that provides a great environment for bacteria to grow.
There are two different classification of Dacryocystitis:
acute or chronic,
acquired or congenital.
The chronic form is more common than the acute form. Usually, chronic Dacryocystitis affects adults over 30 years, mainly whites and females are also predisposed to this disease. It has been found in infants as well roughly 1 in 3884 live births (Chakrabarti). Dacryocystitis rarely leads to the disease or deadly sickness. However, in congenital Dacryocystitis there can have a significant morbidity and mortality if not treated correctly and quickly.
Common signs for Dacryocystitis:
Excessive watering of the eyes
Pus or mucus secretions when pressure is applied over the lacrimal sac
Pain/redness
Swelling
Microscopic examination supports the inflammation as the main process in chronic dacryocystits. Studies have shown that this problem seems to affect females more: 77% of females are diagnosed with chronic Dacryocystitis and 23% in males (Chakrabarti). Nearly 3% of all people who visit an eye clinic are due to lacrimal drainage system problems (another name of Dacryocystitis).
Risk Factors
If early recognition and urgent management can prevent potential complications and results in an excellent outcome. The risk factors for congenital and acute dacryocysitis typically effects infants:
gender of the individual. Females have a greater risk due to the fact that the tear ducts are very narrow compared to males.
Age. It affects infants and people older than 30-40 years – a narrowing of the punctual openings that comes with older age slows the tear drainage and causes a blockage.
Types of Dacryocystitis and its Causes
There are different types of Dacryocystitis; acute, chronic, acquired and congenital. An acute infection is caused by multiple bacterium; “Staphylococcus, Streptococcus, followed by Haemophilus influenza and Pseudomonas aeruginosa” (Taylor).
Chronic infection is a result of a long-term obstruction or due to repeated infection. The acquired dacryocystitis are usually “due to repeated trauma, surgeries, and medications” (Taylor).
Finally, congenital forms are typically because of a membrane obstruction in the nasolacrimal duct. This form occurs in infants, but develops before delivery. Amniotic fluid fails to escape the nasolacrimal system therefore, an obstruction is causing Dacryocystitis.
Symptoms
Acute Dacryocystitis symptoms start suddenly and often include a fever and pus from the eye. A doctor will prescribe antibiotics to treat the bacterial infection. If treated correctly, it resolves within a few days.
In patients with chronic Dacryocystitis symptoms are formed gradually over time. There are often less severe symptoms, fever and pus may not even be present. Unfortunately, people experience long lasting pain and discomfort in the eye area.
Acute and chronic Dacryocystitis present symptoms of:
Watery eyes
Excessive tears
Redness and swelling
Pus/thick discharge (may not be present in chronic)
Pain
Fever (may not be present in chronic)
These symptoms vary in intensity from person to person and it also depends on the type presented.
Diagnosis
A diagnosis is primarily based on the medical history of the individual, and physical exam findings from the doctor. On exam an eye doctor is looking for swelling or redness mainly. To test the problem the doctor will press on the lacrimal sac via the Crigler massage to see if any pus or discharge comes out in the eyelid opening. If there is, a sample is collected to test for bacteria.
In patients with a fever or acute visual changes, a laboratory study and blood cultures are considered (Taylor). A strong consideration for a CT scan if there is an extensive infection suspected. If there are any anatomical concerns, a dacryocystogram (DCG) can be ordered. In a chronic case, “serological testing can be done if systemic diseases are suspected as the underlying cause” (Taylor).
Expected Duration
Acute Dacryocystitis is usually resolved within days of treatment with antibiotics since symptoms are seen quickly. In certain cases, if acute Dacryocystitis is left untreated it will move on to chronic Dacryocystitis. The symptoms are often less severe and more gradual. That being said, treatment with antibiotics is often used as a conservative measure. But, if the disease is severe enough, there is a need for surgery which attempts to dilate the canal. Congenital Dacryocystitis tends to resolve on it’s own by six to twelve months with conservative measures (Taylor).
Prevention
There is no way to prevent dacryocystitis in babies, as this is an inherited cause. But there are ways to prevent an infection. Learning the Crigler massage will help release fluid and open up tissue that could be covering the tear duct. In certain cases after surgery, the widened duct makes it less likely for blockage.
It is very important to prevent or treat infection. There are reports of rare complications, including eye blindness. Abrar K Alsalamah and colleagues from Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia described a case of otherwise healthy adult who presented with complete visual loss following orbital cellulitis and abscess formation secondary to acute dacryocystitis.
When to call a doctor
It is possible for acute Dacryocystitis to resolve on its own without treatment but it is recommended to see an eye doctor. Acute Dacryocystitis can quickly turn into chronic when it goes untreated. If an individual is presented with the above symptoms, then there is cause to see a specialist.
