From the Guidelines
Dacryocystitis is an infection of the lacrimal sac, which is part of the tear drainage system located between the inner corner of the eye and the nose, typically presenting with pain, redness, swelling, and sometimes discharge at the inner corner of the eye, and is usually caused by a blockage in the nasolacrimal duct that allows bacteria to accumulate and cause infection, as noted in the 2013 IDSA and ASM guidelines 1.
Key Characteristics of Dacryocystitis
- It can be acute or chronic
- Common bacterial causes include Staphylococcus aureus, Streptococcus pneumoniae, and gram-negative bacteria, although the exact microbiology can be difficult to determine due to the presence of indigenous skin microflora 1
- Symptoms include pain, redness, swelling, and discharge at the inner corner of the eye
Diagnosis and Treatment
- Diagnosis should follow strategies similar to those for conjunctivitis, considering the microbiologic data and the potential for gram-positive bacteria, gram-negative bacteria, anaerobes, and fungi to be involved 1
- Treatment for acute dacryocystitis typically involves oral antibiotics, with the specific choice depending on the suspected or confirmed causative organism
- Warm compresses can help reduce pain and swelling
- For chronic or recurrent cases, surgical intervention such as dacryocystorhinostomy (DCR) may be necessary to create a new drainage pathway
Important Considerations
- Dacryocystitis is more common in infants and adults over 40, particularly women
- Prompt medical attention is important when symptoms develop to prevent the infection from spreading to surrounding tissues and causing serious complications
- The condition's management should prioritize reducing morbidity, mortality, and improving quality of life, guiding the choice of treatment and follow-up care 1
From the Research
Definition and Overview of Dacryocystitis
- Dacryocystitis is an infection or inflammation of the lacrimal sac, usually caused by a blockage of the nasolacrimal duct 2.
- The most common sign of this entity is the distal nasolacrimal duct obstruction, which should be treated to prevent clinical relapse 2.
Causes and Risk Factors
- The germs isolated in cases of dacryocystitis include Gram-positive bacteria such as S. aureus, S. pneumoniae, and S. epidermidis, as well as Gram-negative bacteria like H. influenzae and P. aeruginosa 2, 3.
- Recent studies suggest an increasing incidence of Gram-negative bacteria and methicillin-resistant Staphylococcus aureus in dacryocystitis 4, 5.
Symptoms and Diagnosis
- Acute dacryocystitis is frequently extremely painful and slow to resolve even with systemic antibiotic therapy 3.
- The diagnosis of dacryocystitis can be made based on clinical signs and symptoms, and culture results can help guide antibiotic treatment 4, 5, 6.
Treatment and Management
- Antibiotic therapy against Gram-positive and Gram-negative bacteria should be administered, orally in adults and intravenously in pediatric patients, prior to surgery 2.
- Gentamicin and amoxicillin-clavulanic acid have been found to be effective against the bacteria commonly implicated in the etiopathogenesis of dacryocystitis 2.
- Incision, drainage, and direct application of antibiotics inside the infected sac can result in almost immediate resolution of pain and rapid control of infection 3.
- Understanding the bacteriology and antimicrobial susceptibility of the region is crucial for the empirical antibiotic selection in clinical practice 5.