Acute Dacryocystitis – signs and symptoms to watch

Many patients worry that they might have an acute dacryocystitis when they get a watering or sticky eye. How can you know for sure?
Acute dacryocystitis is when there is swelling and infection of the lacrimal sac at the corner of the eye just below the tendon which joins the upper and lower lid towards the nose.

The lacrimal sac sits in a little bony fossa called the lacrimal fossa on the anterior medial orbital wall. On one side of it, there is bone (the medial side towards the nose). The lower end of the sac opens into the nasolacrimal duct which goes down into the nose. The upper end is by the tendon and the lateral side of it has the entry points of the canaliculi, which bring in the tears draining from the eye surface.

If there is a swelling in the lacrimal sac area, it’s because the lacrimal sac is either full of mucus or pus. The swelling can get infected and be red and painful and then that is called an acute dacryocystitis. If there is just swelling without the redness and pain, then it is called a mucocele.

Both an acute dacryocystitis and a mucocoele lump are both highly indicative of a problem in the nasolacrimal duct. When you lump, you will also be very likely too also have quite a troublesome watering eye. Sometimes the swelling is caused by a tumour; fortunately that is very rare.

A part of the workup by the oculoplastic and lacrimal Surgeon at Clinica London is to establish what is causing the watering eye, what is causing the swelling of the lacrimal sac and whether the tear drainage obstruction arises from within the sac or below the sac.

At Clinica London, we run the Tears Clinic for patients with dry and watering eyes and will gently examine your tear drainage system and look inside your nose to see the opening of the ducts using nasal endoscopy and exclude pathology in the nose that could be blocking the duct.

As an oculoplastic surgeon, I am trained both in ophthalmology and have been trained by ENT surgeons to look in the anterior nose. I went to Boston – to the Massachusetts Eye and Ear Hospital – to do a course in endoscopic lacrimal surgery, and I have also been very fortunate to have trained with Mr Ian Mackay and Mr Hesham Saleh. Both are otolaryngology surgeons who were and are still respectively at the Charing Cross Hospital (Imperial College NHS Trust) where I used to be a consultant ophthalmologist running the oculoplastic and lacrimal service.

I have also written a book called the Colour Atlas of Lacrimal Surgery and am currently writing another book on Watering and Dry Eyes. I am president elect of the International Society of Dacryology and Dry Eyes.

I love looking after patients with dry eyes and watering eyes as so much can be done to help them get better. As a result of my training and experience, I am able to both diagnose nasal causes of watering eyes and to treat watering eyes endonasally with what is called an endonasal endoscopic (with an endoscope) dacryocystorhinostomy or DCR, which gives results in the range of about 95% success.

If you have a watering eye and if you think you have got acute dacryocystitis or a mucocele because there is a lump at the corner of the eye, you should have a consultation with me to assess what the problem is and advise you. We have all the most up to date probing and imaging techniques at Clinica London to help diagnose the cause of your watering eye problem.