Acute dacryocystitis in adults
Acute dacryocystitis in adults is a painful condition of the tear sac (lacrimal sac) when the tear duct is blocked. The tear sac fills with tears and mucus, which then becomes infected and forms a red lump at the corner of the eye on the side of the nose.
Since this is an acute condition, it requires urgent treatment. Sometimes it causes an outright abscess which requires immediate drainage and packing. Fortunately, acute dacryocystitis is recognised much earlier, and the abscess can often be avoided by prompt antibiotic treatment and DCR.
When acute dacryocystitis in adults occur, the first thing to do is for the GP to give them antibiotics by mouth for a few days and see if there is a response, as well as organising a referral to the Oculoplastic Surgeon. If there is not a rapid response, then the abscess has to be drained surgically through the skin or drained endonasally into the nose.
If the nasolacrimal duct obstruction is allowed to persist, then the acute dacryocystitis will recur. Patients with acute dacryocystitis virtually all require a DCR operation. DCR stands for dacryocystorhinostomy and is done by myself, Jane Olver, here at Clinica London.
Very rarely, acute dacryocystitis is caused by lacrimal sac tumour, or a skin lymphoma, which has invaded inwards to the sac. These less common causes have to be considered, particularly if there are any features about the acute dacryocystitis which do not quite fit and give cause for alarm. This is a “Red Flag” situation.
Often we will take a biopsy at the same time as doing the DCR if we have any suspicion that it may not be just acute dacryocystitis from a blocked tear duct.
Acute dacryocystitis is becoming less common in the UK, than in some more distant countries where the medical facilities are not so easily available to everybody. Such patients will get chronic dacryocystitis with discharge through the skin onto the face if not treated adequately. Fortunately, here in the UK, we can recognise acute dacryocystitis early and have a rapid referral to the oculoplastic lacrimal surgeon for assessment and subsequent surgery.
The operation of choice is a direct drainage through the skin or the nose, with a DCR done at the same time.
A non-inflamed swelling of the lacrimal sac is called a mucocele and can predispose to acute dacryocystitis which also requires treating surgically. The mucocele is a lacrimal sac swelling at the corner of the eye, on the side of the nose, which is secondary to the lacrimal sac filling with mucus, which is not yet infected, and which cannot drain down the tear duct because it is very narrow or entirely blocked.
The mucocele can lead to acute dacryocystitis if it gets infected. It can easily become infected because it is a stagnant pool of tears and mucous. A simple mucocele also has to be treated by DCR in the same way as a simple blocked tear duct, and this can be done by an endoscopic endonasal DCR, by an external DCR, or depending on patient preference, a combined external and endoscopic endonasal DCR, or LighTears.