From the Research
For lacrimal stones (dacryoliths), the most effective antibiotic treatment, based on the latest evidence, is trimethoprim/sulfamethoxazole, as recommended by the 2024 study 1. This is due to the high resistance rates of commonly used antibiotics such as β-lactams and fluoroquinolones. The recommended treatment approach should prioritize the use of antibiotics with low resistance rates, such as trimethoprim/sulfamethoxazole, for both systemic and topical single-agent treatments. Some key points to consider in the management of lacrimal stones include:
- The importance of proper ophthalmologic evaluation to diagnose and treat any associated infections or conditions, such as dacryocystitis, which may require prompt attention.
- The use of warm compresses applied to the inner corner of the eye several times daily to provide symptomatic relief while awaiting definitive treatment.
- The consideration of surgical intervention, such as dacryocystorhinostomy (DCR), to remove the stones and create a new drainage pathway, as this is often the most effective treatment for symptomatic dacryolithiasis, as noted in the 2017 review 2. It is essential to note that the treatment of lacrimal stones should be individualized based on the patient's specific condition and the presence of any associated infections or complications. The 2024 study 1 highlights the importance of selecting antibiotics with low resistance rates, which is crucial in ensuring effective treatment and minimizing the risk of complications. In contrast, older studies, such as the 2009 study 3, provide limited guidance on the optimal antibiotic treatment for lacrimal stones, as they focus on the clinical and histopathological characteristics of lacrimal gland stones rather than the treatment of dacryoliths. Similarly, the 2004 study 4 discusses the use of moxifloxacin in the treatment of bacterial infections but does not provide specific guidance on the treatment of lacrimal stones. The 1999 study 5 suggests that oral and topical antibiotic therapy may be effective in treating complete, primary acquired nasolacrimal duct obstruction in adults, but this study is outdated and does not reflect the current understanding of the optimal treatment approach for lacrimal stones.