From the Research
The initial treatment for a patient with a stenosed lacrimal duct and dacryocystitis involves a combination of antibiotics and supportive measures, with a focus on controlling the acute infection and inflammation before considering more definitive interventions such as dacryocystorhinostomy, as suggested by the most recent study 1. The treatment regimen should include oral antibiotics, such as amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or, in case of penicillin allergy, azithromycin (500 mg on day 1, then 250 mg daily for 4 days), as well as topical antibiotic drops like moxifloxacin or ofloxacin 4 times daily.
- Warm compresses should be applied to the affected area for 10-15 minutes, 3-4 times daily to reduce inflammation and promote drainage.
- Gentle massage of the lacrimal sac area in a downward direction may help facilitate drainage.
- Pain management with acetaminophen or NSAIDs is appropriate as needed. The antibiotics target the common pathogens involved (typically Staphylococcus aureus, Streptococcus pneumoniae, or gram-negative bacteria), while the warm compresses help increase blood flow to the area, promoting healing and reducing swelling, as noted in 2 and 3. If symptoms don't improve within 48-72 hours or if the condition is severe with abscess formation, the patient should be referred for possible surgical intervention, such as dacryocystorhinostomy, which is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct, as stated in 4 and supported by the findings in 5.