What is dacryocystitis?
Dacryocystitis is an infection of the tear sac, a small pouch located at the inner corner of the eye that collects tears as they drain from the eye's surface. Under normal circumstances, tears flow from the eye through small drainage openings at the inner corner of the eyelids, into the tear sac, and then down through a channel into the nasal cavity. When this drainage pathway becomes blocked, tears and mucus accumulate in the tear sac, creating an environment where bacteria can grow and cause infection.
Dacryocystitis can develop suddenly or build gradually over time as a chronic, recurring condition. Acute cases typically present with significant pain, redness, and swelling at the inner corner of the eye and require prompt treatment to prevent the infection from spreading. Chronic dacryocystitis tends to cause milder but persistent symptoms including tearing, discharge, and recurring episodes of inflammation.
Tear duct infection treatment depends on whether the condition is acute or chronic, and whether an underlying tear duct blockage is driving the recurrent episodes. In most cases, the underlying blockage must also be addressed to prevent dacryocystitis from returning.
Types of dacryocystitis
Dacryocystitis is classified by how it develops and how long it has been present:
Acute dacryocystitis – A sudden onset infection of the tear sac that causes significant pain, redness, swelling, and tenderness at the inner corner of the eye
Chronic dacryocystitis - A persistent or recurring low-grade infection of the tear sac
Congenital dacryocystitis - Infection of the tear sac in newborns, most commonly caused by a congenital blocked tear duct
What are the symptoms of dacryocystitis?
Symptoms of dacryocystitis vary depending on whether the infection is acute or chronic. Common signs include:
- Pain, redness, and swelling at the inner corner of the eye
- A tender lump or bump at the side of the nose near the inner corner of the eye
- Excessive tearing or watery eyes
- Mucous or pus-like discharge from the eye or drainage opening
- Crusting along the eyelid or at the inner corner of the eye
- Fever and general feelings of illness in more severe acute cases
- Blurred vision caused by discharge on the eye's surface
- Visible pus or discharge when gentle pressure is applied to the inner corner of the eye
In acute dacryocystitis, symptoms typically develop quickly and are often severe enough to prompt urgent medical attention. In chronic dacryocystitis, symptoms may be subtle and persistent, with periodic flare-ups of more significant inflammation.
Any swelling, pain, or redness at the inner corner of the eye that does not improve within a day or two should be evaluated promptly. Untreated acute dacryocystitis can progress to a tear sac abscess or, in rare cases, spread to surrounding tissue.
What causes dacryocystitis?
Dacryocystitis almost always develops in the setting of a blocked tear duct. When the normal flow of tears through the drainage system is obstructed, bacteria that are normally flushed away with the tear flow instead accumulate and multiply within the stagnant tear sac. Common causes and contributing factors include:
- Narrowing or complete blockage of the channel that drains tears from the tear sac into the nasal cavity
- Age-related narrowing
- Congenital blocked tear duct in newborns and young infants
- Injury or structural changes to the bones around the nose and inner eye area
- Chronic sinus or nasal conditions, such as nasal polyps or chronic sinusitis
- Small stones, known as dacryoliths, that form within the tear sac from accumulated debris
How is dacryocystitis diagnosed?
Dacryocystitis is typically diagnosed through a clinical examination. An oculofacial plastic surgeon will assess the location, degree, and characteristics of the swelling and tenderness at the inner corner of the eye, evaluate the drainage openings, and look for discharge or pus that can be expressed from the tear sac with gentle pressure.
In cases of acute dacryocystitis with symptoms such as fever, blood tests may be ordered to assess the severity of the infection. A CT scan may be performed when abscess formation is suspected or when the extent of the infection needs to be assessed before treatment.
How is dacryocystitis treated?
Treatment of dacryocystitis addresses both the active infection and, once the infection has resolved, the underlying tear duct blockage that caused it. Without treating the blockage, dacryocystitis is likely to recur.
Mild to moderate acute dacryocystitis is typically managed with oral antibiotics to clear the infection. Warm compresses applied to the inner corner of the eye several times daily can help relieve discomfort and encourage drainage. Topical antibiotic eye drops may be used alongside oral antibiotics in some cases.
When acute dacryocystitis has progressed to abscess formation, the abscess may need to be drained surgically before antibiotics can fully resolve the infection.
Severe or rapidly progressing dacryocystitis, particularly in cases accompanied by fever or spreading redness and swelling, may require intravenous antibiotics and hospital admission.
Once the acute infection has cleared, surgery is recommended to address the underlying blockage and prevent recurrence. The standard surgical treatment is dacryocystorhinostomy (DCR), a procedure that creates a new drainage pathway between the tear sac and the nasal cavity, bypassing the obstructed segment entirely.
DCR can be performed using two approaches:
- External DCR involves a small incision on the side of the nose to access the tear sac and create the new drainage opening directly
- Endoscopic DCR is performed entirely through the nasal cavity using a small camera, leaving no external incision or visible scar
Recovery following DCR is generally well tolerated. Mild swelling, bruising, and nasal congestion are expected in the first one to two weeks. Most patients experience lasting resolution of both their tearing and their recurrent infections once the new drainage pathway has fully healed.
Whether you are dealing with an acute infection or a pattern of recurring episodes, the oculofacial plastic surgeons at The Iowa Clinic can evaluate your tear drainage system and recommend the most effective course of treatment. Call 515.875.9480 to schedule an appointment.