Tear Ducts | Clogging & Infection (Dacryocystitis)
Under normal, healthy circumstances, tears you make flow unobstructed into your tear (nasolacrimal) duct and through to your nasal passages.
Dacryocystitis (pronounced “dak-ree-oh-sis-ty-tus”) happens when this pathway is blocked.
When tears can’t move, the fluid can become stagnant and infected and result in a host of health concerns. It’s most common in infants and adults over 40 years of age.
TYPES OF DACRYOCYSTITIS
Acute – Comes on suddenly, often from bacterial infection, and resolves quickly, generally under three months.
Chronic – Lasts a long time, frequent. More often linked to systemic (whole body) and autoimmune conditions.
Congenital – Present at birth; membrane obstruction.
Acquired – Results from environmental, anatomical, or experiential factors such as broken bones, surgeries, an unusual nasal structure, tumors, aging, or using certain medicines.
SYMPTOMS
Signs and symptoms of Dacryocystitis can include excessive eye watering or crusting around the eye. If the duct is infected, additional symptoms may also include:
- Swelling around your eye.
- Redness or skin darkening.
- An abscess or sore that may have discharge (pus) in the inner corner of your eyelids.
Signs and symptoms of chronic Dacryocystitis may be less severe than those of acute Dacryocystitis.
You should always check with your healthcare provider if you have any symptoms. Left untreated Dacryocystitis can lead to an open sore and possible vision issues.
CAUSES
The common cause of Dacryocystitis is an obstruction of the nasolacrimal duct, which extends from the tear sac into the nose, compromising the tear drainage system. This results in a build-up of tears and bacteria in the lacrimal sac. Stagnation of tears provides a favorable environment for infectious organisms to multiply and for debris to deposit.
DIAGNOSIS
The diagnostic approach generally begins with a thorough patient history and physical exam. Samples of any infectious discharge may be collected to test for pathogens.
In severely acute Dacryocystitis involving visual changes, fever, and orbital cellulitis, imaging of the eye using CT scans and blood tests may be performed to screen for underlying diseases and obstructions.
For chronic Dacryocystitis, blood tests may be performed to screen for underlying diseases. Imaging may also be required if trauma is suspected as a root cause. A nasal endoscopy may also be used to rule out underlying structural abnormalities such as septal deviation.
To test the tear drainage system, a sterile dye can be administered in the corner of the eye to assess whether it drains normally. After five minutes, if the dye remains stagnant in the eye or has drained over the lower eyelid and down the cheek, there may be an obstruction.
When prudent, an Ophthalmologist will be engaged for consultation and expertise.
TREATMENT
Treatment recommendations / options will vary based on the type and severity of the condition:
Acute – Is typically addressed with less invasive treatments. Your health care provider might recommend warm compresses, massage, drop or ointment, and antibiotics for an infection. Or the provider might advise having a procedure to try to dilate the nasolacrimal duct.
Chronic – Endoscopic Dacryocystorhinostomy (DCR) is a surgery performed in concert with an eye surgeon to create a new pathway for your tears. It is considered the primary and best option if symptoms are severe. It is a much more common treatment for adults than for children. The physician will discuss if DCR will be best for you.