What is the treatment for dacryocystitis (inflammation of the lacrimal sac)?

From the Guidelines

Dacryocystitis treatment should involve the prolonged use of systemic anti-staphylococcal antibiotics and intensive topical antibiotics and corticosteroids, with consideration for surgical intervention to address underlying nasolacrimal duct obstruction. The treatment approach for dacryocystitis, an inflammation of the lacrimal sac, is multifaceted and aims to address both the infection and the underlying cause, often a blockage of the nasolacrimal duct. According to the most recent guidelines, including those from the study published in 2024 in the journal Ophthalmology 1, cultures are nearly always positive for Staphylococcus aureus, although other organisms are possible, highlighting the need for targeted antibiotic therapy.

Key Considerations in Treatment

• The use of antibiotic regimens typically results in only temporary improvement, necessitating a more prolonged and intensive approach.
• Systemic anti-staphylococcal antibiotics are recommended, given the high prevalence of Staphylococcus aureus in dacryocystitis cases.
• Intensive topical antibiotics and corticosteroids can help manage the infection and reduce inflammation.
• The increasing frequency of methicillin-resistant S. aureus (MRSA) underscores the importance of obtaining conjunctival cultures before starting treatment to guide the choice of antibiotic, as noted in the study 1.

Surgical Intervention

Surgical correction may be necessary to address the underlying obstruction, particularly for cases with concomitant nasolacrimal duct obstruction and chronic dacryocystitis. Procedures like dacryocystorhinostomy (DCR) can create a new drainage pathway between the lacrimal sac and nasal cavity, preventing recurrence by addressing the root cause of the infection.

Adjunctive Therapies

Additional treatments such as warm compresses and topical antibiotic eye drops can be beneficial in managing symptoms and supporting the healing process. However, these should be used as part of a comprehensive treatment plan that includes systemic antibiotics and consideration for surgical intervention, as supported by recent evidence 1.

From the Research

Treatment Options for Dacryocystitis

• The treatment for dacryocystitis, an inflammation of the lacrimal sac, can involve various approaches, including antibiotic therapy and surgical interventions 2, 3, 4, 5, 6.
• Antibiotic therapy is often used to treat the infection, with a focus on targeting both Gram-positive and Gram-negative bacteria, such as S. aureus, S. pneumoniae, S. epidermidis, H. influenzae, and P. aeruginosa 3, 6.
• Specific antibiotics that have been found to be effective include gentamicin and amoxicillin-clavulanic acid 3, as well as levofloxacin and amoxicillin/clavulanate, although resistance to these antibiotics can occur in some cases 6.

Surgical Interventions

• Surgical treatment, such as incision, drainage, and direct application of antibiotics inside the infected sac, can result in rapid resolution of pain and control of infection 2.
• Dacryocystorhinostomy (DCR) is a surgical procedure that can be used to treat dacryocystitis, either as a primary or secondary treatment, and has been shown to be effective in resolving symptoms and preventing recurrence 4, 5.
• Endoscopic DCR (EN-DCR) is a minimally invasive procedure that has been emerging as a preferred treatment option for nasolacrimal duct obstructions, including those caused by dacryocystitis 5.

Timing and Approach to Treatment

• The timing of surgical intervention can depend on various factors, including the severity of symptoms, patient age, and general health status 3, 5.
• Primary EN-DCR has been shown to result in faster resolution of symptoms compared to secondary treatment, with no significant differences in recurrence, safety, or outcomes at postoperative year 1 5.