Dacryocystitis (Tear Sac Infection)

How the tear drainage system works

Tears drain through two tiny openings (puncta) at the inner corners of the upper and lower eyelids, into small channels (canaliculi), then into the tear sac, and down the nasolacrimal duct into the nose. That is why your nose runs when you cry. If the duct below the sac is blocked, tears pool in the sac and bacteria multiply.

Types of dacryocystitis

Symptoms

• pain, redness and swelling at the inner corner of the eye, beside the nose
• a firm, tender lump over the tear sac
• watery eye (epiphora)
• yellow or green discharge, especially when the area is pressed
• crusting of the eyelashes
• fever and feeling unwell in more severe cases
• red eye or conjunctivitis on the same side

Chronic dacryocystitis may cause only constant watering and recurring sticky discharge.

Causes and risk factors

The main cause is a blocked nasolacrimal duct (tear duct stenosis). In adults this is usually from age-related narrowing, which is more common in women because their ducts are narrower. Other causes and risk factors:

• chronic sinus disease and nasal problems such as a deviated septum or polyps
• injury to the nose or face, or previous nasal or sinus surgery
• inflammatory diseases such as granulomatosis with polyangiitis or sarcoidosis
• certain eye drops and some chemotherapy drugs
• rarely, tumors of the tear sac (especially if there is bloody tearing)
• in babies, a membrane at the bottom of the duct that has not opened

The usual bacteria are staphylococci and streptococci. Other bacteria are more common in chronic cases.

Diagnosis

An eye doctor diagnoses dacryocystitis by examination. Gentle pressure over the sac may push pus out through the puncta, which can be swabbed for culture. Other tests:

• lacrimal irrigation: saline flushed through the drainage system after the acute infection settles, to find the blockage
• CT scan if orbital cellulitis, an abscess, or a tumor is suspected
• nasal endoscopy to look for nasal causes

Probing or irrigating during an acute infection is avoided because it can spread infection.

Treatment

Acute infection

• Antibiotics: usually by mouth. IV antibiotics in hospital for severe infection, spreading cellulitis, or young children.
• Warm compresses several times a day.
• Gentle massage of the sac in some cases, if advised.
• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose.
• Draining an abscess if one forms.

Chronic or recurrent dacryocystitis

• Dacryocystorhinostomy (DCR): surgery to create a new passage from the tear sac directly into the nose, bypassing the blocked duct. It can be done through a small skin incision or endoscopically through the nose. Success rates are high, around 90 in 100 or more.
• A small silicone tube may be left in place for a few weeks to keep the new passage open.

Babies

Most congenital blocked tear ducts open by themselves within the first year. Massage of the sac as shown by a doctor helps. Infection needs antibiotics. If the duct remains blocked, probing under brief anesthesia usually cures it. A swollen bluish sac at birth needs prompt assessment.

Complications

• periorbital or orbital cellulitis: spread of infection around or behind the eye
• abscess of the tear sac
• a fistula (abnormal opening) to the skin
• rarely, meningitis or cavernous sinus thrombosis

Frequently asked questions

What causes dacryocystitis?

Dacryocystitis is caused by bacteria growing in the tear sac when the tear duct below it is blocked. In adults the blockage is usually from age-related narrowing. In babies it is often from a duct that has not fully opened at birth.

Is dacryocystitis contagious?

The infection itself is not very contagious, but discharge can carry bacteria. Wash hands after touching the eye, use separate towels, and avoid sharing eye makeup until the infection clears.

How is dacryocystitis treated?

Acute dacryocystitis is treated with antibiotics, warm compresses and pain relief. If infections keep returning or the duct stays blocked, a surgery called dacryocystorhinostomy creates a new drainage path into the nose and usually cures it.

Can a blocked tear duct cause an infection?

Yes. When tears cannot drain, they stagnate in the tear sac, allowing bacteria to grow. This leads to dacryocystitis, with swelling, pain and pus at the inner corner of the eye.

Is dacryocystitis serious?

It is usually not serious when treated promptly. But infection can spread to the tissues around or behind the eye, which can threaten vision. Swelling around the whole eye, eye pain with movement or vision changes need emergency care.