Tearing, redness, swelling – symptoms reminiscent of a spring allergy can lead to a completely different illness. Many patients are only first diagnosed with dacryocystitis in an ophthalmologist’s office.
Dacryocystitis is an inflammation of the tear sac, usually caused by the obstruction of the nasal tear duct. During acute inflammation, symptoms can develop from a few hours to days.
According to Goda Brūzgytė, an eye doctor at the Lirema Eye Clinic, patients with this disease usually complain of pain, redness and swelling in the inner corner of the lower eyelid and tearing of the eye.
“The eye’s conjunctiva can cause redness, mucous or purulent discharge, and a rise in body temperature. The pus secretion often differs through the tear point when pushing a torn tear bag,” says the ophthalmologist.
In patients with chronic dacryocystitis, the main complaint is tearing. Still, discharge may also occur, and slight swelling may be seen in the projection of the tear sac. In the case of congenital dacryocystitis, the newborn tears and crushing are observed, the eye’s conjunctiva may turn red, and the mucous-purulent secretion is squeezed from the tear sac.
Dacryocystitis can be:
- Acute, lasting less than 3 months. The most common causes of acute infection are streptococci, staphylococci, pseudomonas;
- Chronic, that lasts for more than 3 months. It usually develops due to recurrent infection and chronic inflammatory changes in the tear duct system, tears duct concretions, systemic diseases;
- Congenital, which generally develops due to an unopened nasal tear duct membrane in the distal duct;
- It is acquired due to damage to the tear system after trauma or diagnostic/surgical interventions, tumours of the tear system, long-term use of topical medications, and systemic diseases: Wegener’s granulomatosis, sarcoidosis, systemic lupus erythematosus.
Incidence Increases With Age
Dacryocystitis is a reasonably common ophthalmic disease and is usually seen in two age groups, most commonly in the first weeks of life (congenital dacryocystitis) and those over 40 years of age.
“The most common cause of this disease is the obstruction of the nasal tear duct. In a healthy duct, even during conjunctivitis, tears flow quickly into the nasal cavity without causing inflammation of the tear sac. Still, impaired tear leakage in the tear sac causes stasis, thus creating conditions for inflammation and bacterial infection,” explains G. Brūzgytė.
According to the doctor, this pathology occurs in 3-6% of newborns, but only up to 3% of them develop acute dacryocystitis. In adults, the incidence of the disease increases with age – the tear dent narrows, which slows down the flow of tears.
Dacryocystitis is also more common in women than men due to the anatomically narrower nasal tear duct. According to some studies, women make up 80 percent of cases of chronic dacryocystitis.
“Other risk factors that can cause the occlusion of the duct canal are a distortion of the nasal septum, rhinitis, inflammation of the nasal passages, nasal congestion, polyps,” says the ophthalmologist.
If Not Treated In Time, Complications May Occur
Acute dacryocystitis is usually treated with oral antibiotics and warm compresses. As the disease progresses, treatment with intravenous antibiotics may be required, and opening may occur if the abscess forms.
“Chronic dacryocystitis, when the inflammatory process is involved, is treated surgically – usually, dacryocystorhinostomy is performed. During the operation, an opening is formed to drain the tears from the tear sac into the nasal cavity. This bypasses the nasal tear duct obstruction, improving tear drainage and relieving symptoms,” says G. Brūzgytė.
Congenital obstruction of the nasal tear duct is usually treated with massage and hygiene in the area of the tear sac. Topical droplets of antibiotics are given in the presence of purulent discharge.
According to the doctor, for infants up to 6-12 months of age, in about 90 percent of cases, the nasal tear duct opens by itself. If conservative treatment is ineffective, tear duct probing is performed. Sometimes the disease can be complicated by acute infectious inflammation of the tear sac and the formation of abscess – in which case inpatient treatment is required.
If you notice any of these symptoms – pain, redness, swelling in the tear sac projection, tearing, discharge, redness of the conjunctiva, fever – it is recommended that you contact your eye doctor immediately, who will accurately assess the condition and prescribe the necessary treatment.
“Self-treatment of acute dacryocystitis at home is not recommended – improper treatment of the disease can progress and cause dangerous complications. There are no specific preventive measures for this disease. Proper hygiene of the eye and nasal mucosa and timely treatment of infectious diseases are needed,” concludes ophthalmologist G. Brūzgytė.