From the Research
The recommended treatment for acute dacryocystitis is a combination of antibiotics and management of the underlying nasolacrimal duct obstruction, with a recent study suggesting that translacrimal canalicular drainage and D-silicone intubation is a feasible, minimally invasive, safe, and effective method 1. The initial therapy should include broad-spectrum oral antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or, in cases of penicillin allergy, trimethoprim-sulfamethoxazole or a fluoroquinolone.
- For severe cases with significant cellulitis or systemic symptoms, intravenous antibiotics may be necessary, often using ceftriaxone (1-2g daily) or vancomycin (15-20 mg/kg every 12 hours) if MRSA is suspected.
- Warm compresses should be applied to the affected area for 10-15 minutes, 3-4 times daily to help with pain relief and promote localization of any abscess.
- If an abscess forms, incision and drainage may be required. Some key points to consider in the treatment of acute dacryocystitis include:
- The use of endoscopic dacryocystorhinostomy (DCR) with silicone intubation guided by a soft probe has been shown to be a promising alternative for the primary treatment of acute purulent dacryocystitis 2.
- A study published in 2020 found that primary endoscopic DCR appears to be an effective modality in the management of acute dacryocystitis and lacrimal abscess, resulting in rapid resolution of inflammation and comparable surgical success with traditional approaches 3.
- The time interval to surgery and the type of surgery performed can depend on the clinical signs and symptoms, age, and general status of the patient 4. The most recent and highest quality study suggests that translacrimal canalicular drainage and D-silicone intubation is a viable treatment option for acute dacryocystitis, with all patients showing improvement of signs and symptoms within 72 hours and no recurrence of lacrimal sac abscesses after D-silicone tube removal 1.