Dacryocystitis is the medical term used for inflammation of lacrimal sac. The lubrication comes from the tears that is produced by lacrimal glands.
Nasolacrimal duct obstruction (NLDO) is the main cause of dacryocystitis. There are two categories which are duration and onset.
The duration can be acute or chronic. It refers to the duration of the symptoms present. Acute has a time frame of less than three months. Systemic antibiotic therapy is the intervention given for acute dacryocystitis. Chronic persists for a long time which requires surgical therapy for its cause. This type of dacryocystitis has less inflammatory signs.
The onset can be congenital and acquired causes. Knowing the cause of NLDO helps you to know the algorithm for treatment. The congenital type of dacryocystitis is due to the obstruction of the Hasner valve.
Acquired type of dacryocystitis is due to aging, systemic disorders such as sarcoidosis, trauma, surgeries, neoplasms, and medications including timolol, pilocarpine, idoxuridine, and trifluridine.
A few days after childbirth, the amniotic fluid should be expelled from the nasolacrimal system. If it is not expelled, it becomes purulent and leads to neonatal dacryocystitis.
Most cases of dacryocystitis are congenital or occur after birth and acute type. It usually occurs in adults that are beyond the age of 40 years old.
Risk Factors of Dacryocystitis
There are a variety of risk factors for dacryocystitis but it is commonly related to the obstruction of the nasolacrimal duct. These are the following risk factors:
- Females have a narrower duct diameter than males which means that they are at a greater risk for this anatomical reason
- Older people because they have a narrow punctual opening and slowed tear drainage
- Debris in the nasolacrimal system
- Deviation in the nasal septum
- Trauma from endoscopic or endonasal procedures that causes damage to the nasolacrimal system
- Neoplasm in the nasolacrimal system
- Systemic diseases including Wegener’s granulomatosis and Systemic Lupus Erythematosus (SLE)
Signs and Symptoms of Dacryocystitis
The presentation of symptoms and signs differ for acute and chronic dacryocystitis. The symptoms can present for several hours to days in cases of acute dacryocystitis. It is characterized by pain, redness that extends to the bridge of the nose, and edema in the medial canthus. Sometimes there is purulent material that is expelled in the puncta.
Excessive tearing and discharge in the eye is the most common symptom of chronic dacryocystitis. You can experience changes in visual acuity because of tear film production.
There can be devastating complications but the prognosis of dacryocystitis is positive and good.