Dacryocystitis
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.
In this article:
Treatment
If an individual is first-time diagnosed with acute dacryocystitis, the treatment is conservative: a warm compress and an attempt of Crigler massage. The massage technique is mainly used for children, the parent will use their fingers and push to the bone to decompress the top of the nasolacrimal sac.
Usually, doctors will treat acute dacryocystitis with oral antibiotics. Some practitioners use topical antibiotics as well, and for more severe symptoms there may be a need for hospitalization and intravenous (IV) antibiotics. For infants the tear ducts usually out-grow the blockage between 9 to 12 months of age.
To treat chronic dacryocystitis a doctor will prescribe steroid eye drops to reduce swelling that might be obstructing the tear ducts. Conservative measures are always recommended first, such as Crigler massage and topical heat. Over-the-counter pain relievers and ani-inflammatory medication may help manage the pan and fever. There may be a need for surgery. First, a surgical probing, which manages the chronic cases, can be done in an outpatient setting. Second (and more likely surgical option) is a dacryocystorhinostomy (DCR) or endonasal dacryocystorhinostomy (EN-DCR), which will widen their tear ducts or bypass the blockage (Taylor).
Surgical Intervention for Dacryocystitis
For dacryocystitis a surgical intervention would involve a dacryocystorhinostomy (DCR) procedures.
Surgery for dacryocystitis is necessary if there is increase in:
- Swelling
- Tenderness around the eye
- Irritation
- Mucous discharge
Is surgery always needed? While there are disturbing symptoms that may force the consultation for this procedure, not everyone who has blockage needs or choses DCR. As a matter of fact, most blocked tear ducts resolve on their own in children. There are also some complications to be considered.
The purpose of this surgery is to help unblock the tear duct(s). A DRC procedure creates a new, larger tear passageway between the lacrimal sac and the nasal sinus for easy drainage.
The main complications that can occur for this surgery, just like in many eye surgeries, are:
- Infection
- Scarring
- Bleeding.
There is also the risk of the DCR not being effective. This type of treatment is more common for adults. A pediatric specialist might recommend a less invasive treatment for children. Preparation for this procedure include a CT scan, and an MRI scan.
What to expect after the surgery? After the DCR, it is important to follow your doctor’s instructions for the best recovery. There may be a need for antibiotics to prevent infection, also other medication such as steroids, nasal decongestants and pain medication. There will be follow-up’s with your eye surgeon, and continuous care might be needed.
Prognosis
Generally, the prognosis for dacryocystits is good. DCR have been reported to be more that 93-97% successful, and in congenital cases 90% are resolved by six months to the first year with conservative measures (Taylor). If conservative measures fail then a referral to ophthalmology for probing is made. The probing techniques have a high success rate in more than 70% of surgeries.