Symptoms of Dacryocystitis
Sep 29, 2021
Source: Cainiu Health
Dr. Cui Xin
Introduction
1. Epiphora (excessive tearing), commonly presenting as tearing, conjunctival injection, and mucoid or purulent discharge draining from the lacrimal puncta. The severity of symptoms varies depending on the clinical type; typically, acute dacryocystitis has a sudden onset and more severe symptoms than chronic dacryocystitis.
2. Swelling of the lacrimal sac: In patients with acute dacryocystitis, the lacrimal sac area is typically erythematous, swollen, firm, painful, and markedly tender to palpation.
Dacryocystitis is an inflammatory condition of the lacrimal sac caused by nasolacrimal duct obstruction or stenosis leading to infection, or by infections originating from the nasal cavity, eyes, or systemic sources. It is classified into two types: acute dacryocystitis and chronic dacryocystitis. Clinically, chronic dacryocystitis is more common—particularly among middle-aged and elderly women—and acute dacryocystitis often develops on the basis of pre-existing chronic dacryocystitis. So, what are the symptoms of dacryocystitis? The following section addresses this question.
Symptoms of Dacryocystitis
1. Epiphora (Excessive Tearing)
Patients commonly present with excessive tearing (epiphora), conjunctival injection (redness), and mucoid or purulent discharge emerging from the puncta. Symptom severity varies depending on clinical type: acute dacryocystitis typically has a sudden onset and more severe manifestations than chronic dacryocystitis. In chronic cases, accumulated pus provides a favorable environment for highly virulent bacteria—especially Streptococcus pneumoniae and Streptococcus pyogenes—to proliferate. Pus frequently drains into the conjunctival sac, resulting in chronic conjunctivitis and potentially progressing to suppurative dacryocystitis.
2. Lacrimal Sac Swelling
In acute dacryocystitis, the lacrimal sac region exhibits marked erythema, induration, tenderness, and pain. In contrast, patients with chronic dacryocystitis may show only mild swelling and tenderness over the lacrimal sac area, along with localized skin erythema, erosion, or thickened, roughened skin; eczema of the lower eyelid may also occur. Acute exacerbations may be accompanied by preauricular lymphadenopathy; severe cases can manifest systemic symptoms such as chills and fever. Following spontaneous or surgical rupture of a lacrimal sac abscess in acute dacryocystitis, a persistent lacrimal fistula may form, resulting in long-term epiphora through the fistulous tract.
Knowledge Extension: Management of Dacryocystitis
1. Medical Therapy
Topical treatment is often initiated early: antibiotic eye drops may be prescribed for initial management. After incision and drainage of an abscess, broad-spectrum antibiotic ointment may be applied locally. Systemic antibiotics—administered orally or intravenously—are primarily indicated during acute episodes. Mild cases may be managed with oral penicillin- or cephalosporin-class antibiotics; moderate-to-severe cases with fever typically require intravenous cephalosporins. For neonates and infants, cefuroxime is commonly used.
2. Surgical Intervention
Incision and drainage of lacrimal sac abscess is performed when fluctuation is detected clinically. A drain may be placed postoperatively to ensure adequate drainage. Laser dacryocanalostomy may be considered if conventional probing fails; it employs laser energy to ablate obstructive or stenotic tissue within the nasolacrimal duct, thereby restoring patency. Dacryocystorhinostomy (DCR) is indicated for severe nasolacrimal duct obstruction and remains the most widely adopted surgical procedure for this condition.
The above outlines the key clinical features of dacryocystitis. We hope this information proves helpful.
