From the Research
Dacryocystitis treatment should prioritize the use of antibiotics effective against both gram-positive and gram-negative bacteria, such as vancomycin, moxifloxacin, and meropenem, as indicated by the most recent study 1.
Treatment Approach
The treatment of dacryocystitis involves a combination of antibiotics, warm compresses, and possibly surgical intervention.
- For acute dacryocystitis, oral antibiotics such as amoxicillin-clavulanate or ciprofloxacin are commonly prescribed, but given the rising resistance and changing microbiology, as noted in 1, more effective antibiotics like vancomycin and meropenem should be considered.
- Topical antibiotic eye drops like moxifloxacin or ofloxacin may also be used.
- Apply warm compresses to the affected area for 10-15 minutes, 3-4 times daily to reduce inflammation and pain.
Surgical Intervention
- For severe cases, intravenous antibiotics may be necessary.
- Chronic or recurrent dacryocystitis often requires surgical intervention, typically a dacryocystorhinostomy (DCR), to create a new drainage pathway between the lacrimal sac and nasal cavity.
- The use of systemic antibiotics during and after DCR surgery may not be necessary, as suggested by 2, but this decision should be made on a case-by-case basis considering the patient's history and current infection status.
Prevention of Complications
- During acute infection, gentle massage of the lacrimal sac should be avoided to prevent spreading the infection.
- Prompt treatment is essential as untreated dacryocystitis can lead to orbital cellulitis or abscess formation.
- The condition occurs due to blockage of the nasolacrimal duct, causing tear stasis and bacterial overgrowth, with a changing microbiologic profile that includes more gram-negative bacteria and resistant species, as highlighted in 3 and 1.