Dacryocystitis
Infection of the lacrimal sac due to nasolacrimal duct obstruction (Staph/Strep)
Overview
Infection of the lacrimal sac secondary to nasolacrimal duct obstruction. Presents with a painful, red, tender swelling at the medial canthus (below the medial canthal tendon) with epiphora. Acute cases need oral antibiotics; recurrent cases need dacryocystorhinostomy (DCR).
Recognise
- Painful, red, tender swelling at the MEDIAL canthus (over the lacrimal sac, inferomedial to the canthus)
- Epiphora (watering) and discharge; pressure over the sac may express pus from the punctum
- Acute on a background of chronic watering (duct obstruction)
Red flags
- Spread to periorbital/orbital cellulitis (lid oedema, proptosis, painful eye movements) → admit
- Congenital dacryocystitis in a neonate (medial canthal swelling) → urgent paediatric ophthalmology
Differentials & how to tell them apart
Investigations
Clinical. Swab any expressed pus. Imaging/syringing later to define the obstruction (not in the acute phase).
Management
Oral antibiotics + warm compresses (DCR for recurrent/chronic obstruction)
- 1Acute: oral antibiotics (e.g. co-amoxiclav) + warm compresses + analgesia. Avoid probing/syringing while acutely infected.Gate: Admit if periorbital/orbital cellulitis develops; urgent referral for a neonate
- 2Definitive treatment of the underlying obstruction once settled: dacryocystorhinostomy (DCR) for recurrent dacryocystitis.
Key points
Tender red lump at the medial canthus + watering eye = dacryocystitis. Swelling above the medial canthal tendon suggests a sac tumour instead.
Monitor & prognosis
Response to antibiotics; recurrence → DCR.
Good acutely; recurrence without treating the obstruction.
Source: College of Optometrists CMG; RCOphth