What Is It?

Dacryocystitis is an infection in the tear ducts of the eye or in the tear sac, also called the lacrimal sac. At the inner corner of each eye are two small tubes or tear ducts. These tear ducts merge into a larger duct on each side of the face, and drain into the nose. At the upper end of the large duct is the lacrimal sac, which fills with tears produced by the lacrimal gland. Periodically, the tears are released from the lacrimal sac into the tear ducts. Because the ducts run from the eye to the nose, tears can drain into the eye or the nose.

Tear-duct infections occur if there is a blockage in the tear ducts that allows bacteria to collect in the ducts or the lacrimal sac. A blockage also can cause excessive tearing from the eye. Blockages typically are caused by:

• A malformation or underdevelopment of the tear ducts
• Trauma to the nose or eyes that damages the ducts, such as a broken nose
• Aging, with gradual enlargement of the facial bones in the region of the nose
• Nasal polyps

Although tear-duct infections can occur at any age, they are most common in infants who commonly have a congenital (inborn) obstruction of the nasolacrimal duct. Infants with this problem have a narrower drainage passageway that will widen with time as they grow. Most children with the disorder outgrow it by the time they are 1 year old. In adults, older people are most likely to get tear-duct infections because their tear ducts become narrowed by continued growth of surrounding bone. The ducts are more rigid and less able to flush out the debris that can cause blockages.

When an infection first occurs, it is said to be acute. If a tear-duct infection is not treated properly, it can last longer and is then said to be chronic.

Typical symptoms of acute tear duct-infection include:

• Pain, redness and swelling of the lower eyelid at the inner corner of the eye
• Excessive tearing
• Pus or discharge from the eye
• Fever

Symptoms of chronic (long-lasting) tear-duct blockage are less severe. Although there may be tearing and perhaps some pus or discharge, usually there is little or no pain, redness or swelling.

Your physician will examine you for signs of swelling and redness at the corner of the eye, excessive tearing, discharge of pus and fever. Pressing on the lacrimal sac may cause mucus or pus to come out of the ducts near the eye. A sample of the discharge can be collected and tested to determine the type of bacteria causing the infection.

If the physical signs are inconclusive, or if the doctor wants to confirm the diagnosis, he or she may perform a dye-disappearance test. With this test, a yellow fluorescent dye is placed in the corner of the eye and allowed to mix with the eye’s film of tears. If the tear drainage system is functioning well, the dye should disappear from the eye’s surface after several minutes. A cotton swab can be inserted into the nose to see if any dye has passed through the tear duct. This test can help your doctor tell whether your tear duct is blocked completely or partially.

Acute tear-duct infections usually will not go away on their own, although the obstruction that results in infection is commonly outgrown in infants by the age of 9 to 12 months. When there is redness or fever and cloudy tear drainage, treatment is necessary. Acute infections will go away quickly with antibiotic therapy. Chronic infections, especially in adults, can be difficult to resolve without surgery to expand the tear duct’s drainage channel.

If a child is prone to tear-duct infections, a routine of warm compresses and pressing on the tear sac with your finger may help promote drainage, making infections less frequent. Wash your hands thoroughly before the treatment. Then, place your index finger sideways along the bony ridge beneath the infant’s eye, with your finger pointing toward the top of the nose. Firmly, but gently, apply pressure with your finger tip between the eye and nose. This pressure will compress and empty the tear sac, flushing the duct below. Follow this compression with warm compresses to the same area.

The first line of treatment for tear-duct infections is usually oral antibiotics. Antibiotics clear up acute infections quickly and can ease symptoms of chronic infections. Most cases of acute, tear-duct infection are treated successfully with antibiotics. In some cases, antibiotic ointment or eye drops may be prescribed. Do not attempt to apply an over-the-counter antibiotic ointment to the eye or the area around the eye.

If the infection does not respond to antibiotics, or if infections keep recurring, minor surgery may be needed. There are several types of surgical treatments for tear-duct infections:

• Surgical probing of the tear duct, in which a thin wire is guided through the tear duct to clear out any blockage. This is the most common treatment for recurring infections in infants.
• Dacryocystorhinostomy, in which the narrowed or blocked duct is expanded. This usually requires removal of bone that has caused the duct’s narrowing. This surgery commonly is done with the aid of a laser.
• Removing all or part of the lacrimal sac

Call your health-care provider if you or your child experience any of the eye symptoms listed above, including pain, excessive tearing, redness, swelling or pus.

There are treatments for just about any cause or severity of tear-duct infection, so the overall prognosis for treated infections is good.

Most children outgrow a problem with blocked tear ducts by the time they are 1 year old.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.