The lacrimal excretory system functions by draining tears into the nasal cavity. The lacrimal duct is continuous with the nasal and conjunctival mucosa and is normally colonized with microorganisms. When the lacrimal duct drainage system gets obstructed, the resulting stagnation of tears leads to dacryocystitis.
Dacryocystitis may present with:
The diagnosis of dacryocystitis is most often made clinically.
DCR is a relatively safe procedure but complications can occur which include:
Acute dacryocystitis is a painful disorder that can affect the quality of life. The morbidity is primarily related to the lacrimal abscess and potential spread to the eye. Chronic dacryocystitis can also lead to a poor quality of life because the constant tearing, mattering and pain.
Congenital dacryocystitis has the highest morbidity and can quickly lead to spread to the eye. Newborns can quickly develop orbital cellulitis, meningitis, brain abscess and sepsis. Even when treated, congenital dacryocystitis can lead to failure to thrive.
Acute dacryocystitis can cause a lacrimal sac abscess and spread of infection. This is a serious condition. Chronic dacryocystitis causes predominantly chronic tearing and watering and is rarely associated with severe morbidity. After surgery, there is a 70-90% success rate, depending on whether the procedure was done open or laser assisted.
Dacryocystitis tended to be more common on the left rather than the right side. It is believed that this may be because the nasolacrimal duct and lacrimal fossa form a wider angle on the right side than on the left side .
Other common causes of lacrimal duct obstruction include:
In congenital cases, there is failure of the duct to canalize and thus the nasolacrimal duct is obstructed. In infants and children, anatomical defects of the mid face should be investigated.
Organisms that cause dacryocystitis include:
Dacryocystitis is not a very common disorder. The exact incidence is not known. The disorder occurs in both gender and is seen at all ages. Infants with congenital facial defects are quite prone to dacryocystitis. In general, the disorder is rare in African Americans because the nasolacrimal ostium is large, straight and less prone to obstruction.
In adults, dacryocystitis is much more common in females than males. Whereas congenital dacryocystitis occurs with equal frequency in both genders. Dacryocystitis has a bimodal age of presentation; it can present in infants and in patients aged 50 or older.
In congenital cases, there appears to be some type of anatomical defect in the facial area that leads to blockage of the nasolacrimal duct. In other congenital cases, there is failure of the lacrimal duct to recanalize.
Over the years, many anatomical variations in the nasolacrimal duct have been observed. Tears generally drain into the lacrimal duct via puncta located in the upper and lower eyelid on the medial side of the eyes. The puncta open up into the nasolacrimal duct which has various folds and valves. The entire lacrimal duct is lined with pseudostratified columnar epithelium. The nasolacrimal duct opens just under the inferior turbinate in the nasal cavity. Any anatomical defect, mass, swelling, edema or trauma along this anatomical route can lead to obstruction and dacryocystitis.
Dacryocystitis is not a preventable disorder. But once it has occurred, the individual can take precautions to keep the disorder from getting worse. This includes applying warm compresses, maintaining good eyelid hygiene and rinsing the eyes and debris regularly. Regular nasal hygiene and irrigation may also help removed any temporary distal obstructions in the lacrimal duct. At the first sign of epiphora, patients should be urged to seek medical assistance.
The nasolacrimal duct plays a role in regulating the flow of tears into the nose. This excretory system when blocked is easily prone to infection and inflammation because the mucosal membrane is normally colonized with microorganism. The blockage of the nasolacrimal duct usually leads to excess overflow of tears (epiphora). The failure to excrete tears in the nasolacrimal duct leads to overgrowth of bacteria in the mucosal lining, eventually causing dacryocystitis.
Dacryocystitis may be acute or chronic. In the acute scenario, there is sudden onset of redness and pain in the medial canthal area. At the same time, the patient complains of an overflow of tears. It has been observed that dacryocystitis is more common the left side. This is believed to be due to the nasolacrimal duct and lacrimal fossa forming a greater angle on the right side than on the left side, which creates an obstruction to tear flow   .
Dacryocystitis is a disorder of the duct which drains tears. The lacrimal duct is located in the corner of the eye where it meets the nose. The duct can be obstructed for many reasons and this can quickly result in an infection. The features of dacryocystitis include excess tearing, pain around the nose and eye, and redness. The diagnosis is made with a clinical exam. The condition needs to be treated otherwise the infection can spread to the eye or brain. Patients need a short admission to the hospital for antibiotics. Use of warm compress and irrigation of the nose also help with the recovery. All patients need a surgical procedure to ensure that the lacrimal duct is open. Once treated, the results are satisfying.