What is chronic dacryocystitis and why should you care?

Chronic dacryocystitis is a tear or lacrimal drainage blockage causing a sharp backup of tears and mucus. There may subsequently occur an infection in the lacrimal sac which produces a little lump at the corner of the eye just below the tendon towards the nose.

If you have a watering eye with a lump below the lacrimal sac, an ophthalmologist should investigate immediately. Usually the type of doctor who looks at watering eyes or an oculoplastic surgeon who has a sub-speciality interest in lacrimal surgery, such as myself.

Fortunately having a chronic dacryocystitis is rare, but sometimes it can be caused by a more sinister aetiology other than just simple wear, tear and ageing, with gradual closing down of the nasolacrimal duct.

There is rarely a sinister cause. For instance, sometimes there can be lymphoma or melanoma or other lacrimal sac lesion or nasolacrimal duct problem that can block a duct and a subsequent dacryocystitis with a watering eye and swelling. The swelling of the sac can be tense, large and red. Then it becomes acutely painful and is called an acute dacryocystitis. Or the tear sac can be swollen, tender, pink and occasionally be discharging, which is having a chronic dacryocystitis.

To treat dacryocystitis, we have to drain the lacrimal sac. Before we do this, we have to investigate by nasal endoscopy, possibly with syringing, and with a CT scan of the head and orbits. The further tests are done in order to exclude any space occupying lesion, in other words, a tumour, which could be within the nose, within the sinus or within the sac resulting in a blocked duct and dacryocystitis.

If the tears have blood in them or if the swelling below the eye is a little bit superior to the or above to the medial canthal tendon then there is a higher degree of suspicion that this may not be simply an ordinary lacrimal sac swelling, but it could be of an invasive cause with a tumour.

There are many ophthalmologists that specialise in lacrimal surgery, and you can find them through the British Oculoplastic Surgery Society website. This link will take you to a map of the UK divided into various regions such as London, the North West, the North East etc. You can see who is in your area, who is trained in oculoplastic surgery, and they are very highly likely to also have been trained in lacrimal surgery. Then, you can contact them, and they can investigate why you have got the watering eye and why you have got chronic dacryocystitis.