Symptoms of Dacryocystitis
Dacryocystitis presents with pain, tenderness, and swelling over the medial canthal region (lacrimal sac area), often accompanied by purulent or mucopurulent discharge from the punctum, and may progress to preseptal or orbital cellulitis if untreated.
Primary Clinical Manifestations
Acute Dacryocystitis
- Pain and tenderness localized to the medial canthal area overlying the lacrimal sac 1, 2, 3
- Swelling and erythema of the medial canthal region, presenting as a tender nodule or mass 4, 3
- Purulent or mucopurulent discharge expressible from the punctum with pressure over the lacrimal sac 5, 3
- Epiphora (excessive tearing) due to nasolacrimal duct obstruction 5
Systemic and Associated Features
- Fever may accompany acute infection 2
- Preauricular or submandibular lymphadenopathy can occur with severe infection 5
- Patients often describe the condition as extremely painful and slow to resolve even with treatment 3
Progression and Complications
Preseptal vs. Orbital Involvement
- Acute dacryocystitis typically presents as preseptal cellulitis since the lacrimal sac lies anterior to the orbital septum 1, 2
- Eyelid edema extending beyond the immediate lacrimal sac area indicates preseptal involvement 2
- Orbital cellulitis is a rare but serious complication that can develop when infection breaches anatomic barriers 1, 2
Warning Signs of Severe Disease
- Visual loss indicates orbital involvement with intraconal abscess formation and constitutes an ophthalmic emergency 1, 2
- Proptosis, ophthalmoplegia, or severe pain with eye movement suggest orbital extension 2
- Abscess formation may be palpable as a fluctuant mass over the lacrimal sac 4, 3
Chronic Dacryocystitis Presentation
- Persistent or recurrent medial canthal pain and tenderness over months 4
- Intermittent discharge from the punctum 4
- Lacrimal sac dilation with chronic fluid collection 4
- Less dramatic presentation than acute disease but with persistent symptoms 4
Clinical Context and Pitfalls
Key Diagnostic Considerations
- The underlying cause is distal nasolacrimal duct obstruction, which must be addressed to prevent recurrence 5
- Many patients have concomitant nasolacrimal duct obstruction that predates the acute infection 6
- Imaging findings show lacrimal sac dilation and fluid collection consistent with dacryocystitis 4
Common Pitfall
Do not dismiss chronic or recurrent medial canthal symptoms as simple conjunctivitis—persistent tenderness and discharge localized to the lacrimal sac area warrant evaluation for dacryocystitis and underlying nasolacrimal duct obstruction 5, 4. Patients with acute dacryocystitis require careful monitoring for signs of orbital cellulitis, as prompt recognition is essential to prevent permanent visual loss 1, 2.