Acute dacryocystitis is an inflammation of the lacrimal sac that causes a painful swelling near the sac. It can develop from chronic dacryocystitis or nearby infections spreading to the sac. Bacteria like streptococcus are common causes. Symptoms include a tender, red swelling by the sac with discharge and fever. Without treatment, the infection can advance to an abscess that may rupture and form a fistula. Treatment involves antibiotics, drainage of any abscess, and dacryocystorhinostomy or dacryocystectomy to prevent recurrence.

1. ACUTE DACRYOCYSTITIS

2.  Definition
 Etiology
 Predisposing factors
 Causative organisms
 Clinical picture
 Complications
 Treatment

3. Acute Dacryocystitis is an acute suppurative
inflammation of the lacrimal sac, characterised by
the presence of a painful swelling in the region of
sac.

4. It may develop in two ways;
 As an acute exacerbation of chronic dacryocystitis
 As an acute peridacryocystitis due to direct
involvement from the neighbouring infected
structures such as; paranasal sinuses, surrounding
bones, dental abscess or caries teeth in the upper
jaw.

5.  Age: more common between 40-60 years
 Sex: predominantly seen in females probably
due to camparatively narrow lumen of the bony
canal
 Heridity: plays an indirect role, it affects the facial
configuration and so also the length and width
of the bony canal
 Poor personal hygeine

6. Commonly involved are;
 Streptococcus haemolyticus
 Pneumococcus
 Staphylococcus

7. It can be divided into 3 stages;
 Stage of cellulitis
 Stage of lacrimal abscess
 Stage of fistula formation

8. It is characterised by;
 Painful swelling in the region of lacrimal sac
 Swelling is red, hot, firm and tender
 Redness and oedema also spread to the lids and
cheeks
 Epiphora
 Constitutional symptoms such as fever, malaise
 When treated resolution may occur at this stage,
if untreated self resolution is rare

9.  Continued inflammation causes occlusion of the
canaliculi due to oedema
 The sac is filled with pus, distends and its anterior
wall ruptures forming a pericystic swelling
 In this way a large fluctuant swelling, the lacrimal
abscess is formed
 It usually points below and to the outer side of the
sac due the gravitation of pus and the presence of
medial palpebral ligament in the upper part

11.  When the lacrimal abscess is left unattended,
it discharges spontaneously, leaving an external
fistula below the medial palpebral ligament
 Rarely, the abscess may open up into the nasal
cavity forming an internal fistula

13.  Acute conjunctivitis
 Corneal abrasion which may be converted to
corneal ulceration
 Lid abscess
 Osteomyelitis of lacrimal bone
 Orbital cellulitis
 Facial cellulitis and acute ethmoiditis
 Rarely cavernous sinus thrombosis and very rarely
generalised septicaemia may also develop

14. During cellulitis stage;
 Systemic(ciprofloxacin or cephalosporin or
tetracycline or cotrimoxazole for 7 days) and topical
antibiotics to control infection
 Systemic anti inflammatory, analgesic drugs and
hot fomentation to relieve pain and swelling

15. During stage of lacrimal abscess;
 In addition to the above treatment when pus starts
pointing on the skin, it should be drained with a
small incision.
 The pus should be gently squeezed out, the
dressing should be done with betadine
 Later depending upon condition of the lacrimal
sac either DCT or DCR operation should be carried
out, otherwise recurrence will occur

16. During external lacrimal fistula;
 After controlling the acute infection with systemic
antibiotics, fistulectomy along with DCT or DCR
operation should be performed

17.  A K KhuranaTextbook of Ophthalmology,
5th edition
 Parsons’Textbook of Ophthalmology, 22nd edition.

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