Acquired dacryocystitis may be chronic or acute.
Acute dacryocystitis is heralded by the sudden onset of pain and redness in the medial canthal region. An insidious onset of epiphora is characteristic of chronic inflammation or infection of the lacrimal sac. Acute dacryocystitis manifests with the sudden onset of pain, redness and swelling overlying the area of the lacrimal sac. Sensitivity is in the medial canthal region but may be extended to the nose, cheeks, teeth and face.
The most serious complications from acute dacryocystitis include the extension into the eye socket with the formation of an abscess and the development of orbital cellulitis. When this occurs, it may lead to blindness, cavernous sinus thrombosis, and even death.
Tearing is the most common symptom of chronic dacryocystitis and is related to the obstruction of the outflow of tears, debris, and epithelial cells from the surface of the eye.
The treatment of dacryocystitis depends upon the clinical manifestations of the disease.
- Acute dacryocystitis necessitates administration of oral antibiotics (e.g. Augmentin).
- Acute dacryocystitis with orbital cellulites necessitates hospitalization with intravenous (IV) antibiotics.
- Congenital chronic dacryocystitis may be treated with lacrimal sac massage, warm compresses, and local and/or oral antibiotics.
- Chronic dacryocystitis almost always requires surgery to treat the symptoms.
In general, treatment of dacryocystitis requires surgery. Surgical success rates of DCR to treat dacryocystitis are around 95%.
For acute dacryocystitis, an external dacryocystorhinostomy is preferred several days after antibiotics were first administered.