Dacryocystitis: Types, Causes, Symptoms, Treatment, Surgery
What is Dacryocystitis?
Our eyes naturally secrete tears to maintain the natural lubrication of them along with a pain-free vision. Most of the tears get drained from the eyes, but some of the excessive tears collect and are drained into the nasal cavity through the lacrimal sac. Infection of this lacrimal sac is known as Dacryocystitis. This infection can occur secondary to obstruction in the nasolacrimal duct, which is located at the junction of the lacrimal sac. Dacryocystitis occurs when there is swelling, irritation and infection of this sac, which also leads to dryness of the eye along with other symptoms. Dacryocystitis can also occur as a result of an infection.
Types of Dacryocystitis and its Causes
Acute Dacryocystitis: It can occur when the tear duct is blocked. It can also occur if there is a stone situated at the opening of the duct. This blockage, which is present at the opening of tear duct, leads to accumulation or retention of mucous and tears inside the sac, resulting in increased chance for developing infections. There are various causes of acute Dacryocystitis including: sinus problems, chronic inflammation, acute physical trauma and rarely tumor. Systematic conditions, such as tuberculosis, sarcoidosis, Wegener's disease can also cause acute Dacryocystitis.
Chronic Dacryocystitis: If the acute dacryocystitis is not treated or managed properly, then it leads to chronic dacryocystitis. In majority of the cases, chronic dacryocystitis occurs as a result of ongoing discharge from the eye, resulting in formation of an abnormal fistula on the sac. One of the most common symptoms of chronic dacryocystitis includes excessive watering or tearing of the eyes. This condition can also obstruct the outflow of the tears, epithelial cells and debris from the surface of the eye.
Signs & Symptoms of Acute Dacryocystitis
- Appearance of a painful, red lump in between the nose and the eyes.
- In extreme cases, the patient is not able to open his/her eyes because of the swelling.
- In acute dacryocystitis, patient experiences non-specific symptoms with localized raised temperature.
- Patient has pain, redness and swelling over the lacrimal sac.
- Patient also has fever.
- There is crusting and tearing of the affected eye.
- Formation of an abscess, which is tender and acute.
- Pus can be expressed upon slight pressure over the lacrimal sac.
- In chronic dacryocystitis tearing of the eyes may be the only symptom.
Dacryocystitis and its Commonly Associated Conditions
Given below are some conditions which are closely related with Dacryocystitis. Patient should seek immediate medical care if they are experiencing these symptoms.
- Conjunctivitis: This is a disease which showcases how harmful any debris can be to our eyes. Conjunctivitis can also occur as a result of exotoxins, which are produced by staphylococcal organisms. These organisms can be present outside the eye and do not get washed away by the normal tearing process.
- Orbital Cellulitis: This is a rare, but very fatal condition, which is also linked with dacryocystitis and more commonly with acute dacryocystitis and congenital acute dacryocystitis. In majority of the patients, there is extreme inflammation of the eye, severe intense pain and irregular motility. Orbital cellulitis also decreases the vision sharpness.
- Cellulitis: This is a serious condition which is characterized by excessive colonization of bacteria, which results from either rupture or considerable damage to the walls of the lacrimal sac which encloses the soft tissue inside. Cellulitis is commonly seen with acute dacryocystitis.
- Periorbital Edema: This occurs as a result of presence of dangerous debris on the surface of the eye. Additionally, the buildup of this debris compounds the risk of infection and secretion of exotoxins, which in turn further disrupts visual functioning.
- Decreased Visual Acuity: This is one of the commonest complaints which the patients have who are suffering from Dacryocystitis. Decreased Visual Acuity means a substantial decrease in the sharpness of vision of the eye. This can occur as a result of overgrowth of the tear film, which deflects the light on the surface of the eye. When there is decreased visual acuity, there is an abnormal proportion as well as composition of the three layers of tear films (mucus, aqueous and oil).
Treatment for Dacryocystitis
Treatment of dacryocystitis should be started as soon as the patient observes the symptoms. For patients who do not have symptoms of infection, but there is blockage of the tear duct, the following steps can be undertaken:
- Apply warm compress on the surface and gently press.
- Gently massage the duct to drain out the pus and debris so as to decrease the risk of infection.
- Antibiotics are the first line of treatment for dacryocystitis. They help in this condition by clearing up the infection and reducing the symptoms.
- Majority of the cases of acute dacryocystitis can be treated easily with the use of antibiotic ointments and eye drops. However, any type of medicine should be used after consultation with the doctor.
Surgical Intervention for Dacryocystitis
If the antibiotics do not help in resolving dacryocystitis, then minor surgical intervention is required, which is extremely successful for treating dacryocystitis. Given below are 2 types of surgical procedures done for Dacryocystitis:
- Balloon dacryoplasty is a surgical procedure where balloons are used to widen the narrow tear ducts. This procedure is not as successful as an endonasal approach. Balloon dacryoplasty is contraindicated in acute dacryocystitis, dacryocystolithiasis and nasolacrimal duct posttraumatic obstruction. Balloon dacryoplasty is more beneficial in nasolacrimal duct occlusion or circumscribed crucial stenosis.
- Endonasal approach with the laser or without the laser is more suitable for patients having chronic dacryocystitis. Endonasal approach helps in restoring the flow of tears from the lacrimal sac and into the nose. In this procedure, the surgeon makes a hole in between the sac and the lacrimal fossa to restore the flow of tears. After the surgery, there are drains and tubes attached to fill the gap and cover the empty space.