From the Research
Dacrocystitis treatment should prioritize a combination of antibiotics and potential surgical intervention, with a focus on targeting gram-negative and gram-positive bacteria, as evidenced by the most recent study in 2024 1. The treatment approach for dacrocystitis involves:
- Oral antibiotics, such as vancomycin, moxifloxacin, or trimethoprim/sulfamethoxazole for gram-positive aerobes, and meropenem, amikacin, or levofloxacin for gram-negative aerobes, as these have shown high sensitivity in recent studies 1
- Warm compresses applied to the affected area for 10-15 minutes several times daily to reduce inflammation and pain
- Incision and drainage in severe cases with abscess formation
- Dacryocystorhinostomy (DCR) as the definitive treatment for chronic dacrocystitis, creating a new drainage pathway between the lacrimal sac and nasal cavity It is essential to administer antibiotics first to control the infection before considering surgery, and patients should seek immediate medical attention if symptoms worsen, as untreated dacrocystitis can lead to serious complications, including orbital cellulitis or cavernous sinus thrombosis 2, 3. The condition occurs due to obstruction of the nasolacrimal duct, causing tear stasis and subsequent bacterial infection, with methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa being common pathogens in acute dacrocystitis, and coagulase-negative Staphylococci in chronic dacrocystitis 1. Key considerations in treatment include:
- Understanding the bacteriology and antimicrobial susceptibility of the region to guide empirical antibiotic selection
- Being aware of the rising incidence of gram-negative pathogens and resistant species in adult dacrocystitis
- Monitoring patients closely for signs of complications and adjusting treatment accordingly 4, 1.