Dacryocystitis - MPO Eyecare Optometry

Dacryocystitis is an inflammatory or purulent—inflammatory lesion of the lacrimal sac. The lacrimal duct, which removes the secret from the lacrimal sac to the mucous membrane of the eye, is quite thin. If for any reason there is an obstacle to the excretion of secretions, stagnation occurs in the lacrimal gland.

Stenosis or blockage (complete or partial) of the duct leads to the development of inflammatory processes. In places of stagnation, swelling, redness occurs and a favorable environment for the reproduction of pathogenic microorganisms is formed.

This disease is treated by an ophthalmologist, in some cases, the patient needs the advice of an ENT doctor.

Types of dacryocystitis

According to the severity of the process , dacryocystitis can be divided into 2 types:

Acute dacryocystitis. It occurs when the lacrimal tubule is completely blocked and pathogens get inside, it can be accompanied by purulent processes and high fever.
Chronic dacryocystitis. It occurs with partial or incomplete blockage of the canal, as well as with pathology of the structure of the lacrimal tract. It has more blurred symptoms, often limited to edema and discomfort without sharp pain. The chronic form, despite less pronounced pain sensations, can be more dangerous than acute, since there is a high probability of complications.

According to the mechanisms of occurrence , dacryocystitis is divided into the following varieties:

viral – occurs as a result of pathogenic viruses entering the duct;
bacterial – with stagnation in the lacrimal sac, it becomes vulnerable to bacteria;
chlamydial (parasitic) – clusters of chlamydia or other unicellular parasitic organisms can cause blockage;
traumatic – with a traumatic lesion, the nasolacrimal duct may be damaged, or swelling after injury leads to its squeezing;
allergic – swelling with allergies can also constrict the tear duct;
congenital – a newborn may have a clogged or insufficiently open tear duct.

Women are more susceptible to diseases. This is due, firstly, to the more miniature structure of the ducts. And secondly, with the ingress of decorative cosmetics into them, which causes blockage and allergic edema.

Dacryocystitis in newborns

During intrauterine development in the fetus, the nasolacrimal canal is closed by a special membrane that breaks through during childbirth or resolves itself shortly before birth. In some infants, the membrane persists on one or both sides after birth, which leads to difficulty in lacrimation and inflammation of the lacrimal sac.

Causes of dacryocystitis

For newborns and infants , frequent factors in the development of the disease are:

the nasolacrimal canal is too narrow;
partial fusion of the lacrimal-nasal canal or preservation of the membrane in it;
corks that have not been absorbed after intrauterine development;
complete overgrowth of the duct (extremely rare).

In adults , the most common causes of darkiocystitis are:

diseases of the nasopharynx, such as sinusitis, sinusitis, nasal polyposis, allergic or colds rhinitis;
injuries to the nose that lead to a rupture of the canal or blockage due to the pressure of traumatic edema on it;
injuries of the eyelids, leading to blockage of the secretion of the lacrimal glands;
ingress of foreign bodies (sand, dust, cosmetics residues) into the duct;
viral or bacterial infections can be both the cause of blockage and its consequence;
infectious skin lesions near the eyes;
hypothermia, leading to thickening of lacrimal secretions and blockage of the canal;
prolonged exposure to high temperatures and dryness, which leads to drying out and blockage of the canal.

Exposure to certain risk factors can constantly lead to the occurrence of chronic dacryocystitis. The influence of external factors, such as working in harmful conditions, is possible. Features of the structure of the lacrimal tract can also be the cause of partial blockage and the occurrence of chronic dacryocystitis.

Risk group

Dacryocystitis is a fairly common disease that can occur in any person. Nevertheless, the risk is higher for some groups of the population.

These include people:

prone to allergic reactions, especially during “seasonal allergies”;
with a chronic decrease in immunity, including in the autumn-winter period;
patients with diabetes mellitus;
having chronic nasal diseases or ophthalmological diseases;
working in harmful or dusty industries;
women who abuse decorative cosmetics.

Symptoms of dacryocystitis

The acute purulent form of the disease is accompanied by the following symptoms:

Swelling of the eyelid and around the eye, narrowing of the eye slit. The eye looks half-closed.
An inflammatory tumor in the area of the lacrimal sac, which can be very painful and hard.
Pain in the eye area and its orbit.
Fever, intoxication of the body.
An abscess that usually opens outwards with the outflow of purulent contents.

In the acute form, the symptoms are expressed both visually and by sensations.

The chronic form of the disease has more blurred symptoms:

copious lacrimation;
edema of the eyelid is not as pronounced as in the acute form;
the tumor of the lacrimal sac is present, but not so pronounced.

Despite the less painful course, the chronic form is even more dangerous with its consequences for the eye. A chronic violation of healthy lacrimation leads to an inflammatory lesion of the conjunctiva (the mucous membrane of the eye). The symptoms of chronic dacryocystitis may be similar to conjunctivitis. But dacryocystitis usually affects one eye, and conjunctivitis affects both at once.

In newborns , dacryocystitis manifests itself as:

constant lacrimation;
swelling of the eyelids;
purulent discharge from the eyes instead of tears.

For infants, this is very dangerous, as complications may occur for both the eyes and nasopharynx, as well as for the brain.

Complications of dacryocystitis

Ignoring the symptoms and postponing treatment can lead to quite serious complications:

an extensive abscess is formed, which can turn into a phlegmon;
the visual function of the eye is impaired as a result of drying out of the conjunctiva and purulent discharge from the tear ducts;
purulent inflammatory processes in the eye threaten dangerous complications for the brain – up to meningitis and encephalitis.

Many people do not like to go to doctors. But dacryocystitis is not a disease that “resolves itself.” Its consequences can be quite harmful, patients should be careful and faithfully follow the recommendations of the attending physician to avoid complications.

Diagnosis of dacryocystitis

For a specialized specialist (ophthalmologist), diagnosis is not a problem, since most of the signs are visible visually. But additional studies are being conducted to clarify the diagnosis, determine the causes and select treatment:

the patency of the lacrimal pathways is determined – a coloring substance is injected into the eye, which, when patency enters the nasal cavity;
probing of the nasolacrimal canal to assess the extent of its lesion;
performing biomicroscopy of the eye;
instillation (fluorescein) test;
Vesta color test;
passive nasolacrimal test;
microbiological examination – seeding of secretions from the lacrimal canal;
x-ray examination using special substances injected into the nasolacrimal canal;
examination of the nose and its sinuses.

The doctor may prescribe, if necessary, one or more additional research methods.

When diagnosing, it is important not only to establish the fact of the disease, but also to determine the causes and choose the most effective treatment methods.

Treatment of dacryocystitis

To eliminate the disease, as well as prevent complications, complex treatment is carried out, which includes:

oral administration of antibacterial and immunostimulating drugs;
topical preparations, mainly in the form of ointments, emulsions;
physiotherapeutic effects – UHF lamps, warming up;
a special massage, which is performed up to 5-7 times a day, to open the tear duct and remove the contents of the tear sac;
opening of the abscess, washing and treatment with antiseptic agents;
formation of a new channel, if necessary, in case it has not recovered itself.

In the case of chronic dacryocystitis, it is possible to use a surgical method – the expansion of the duct and the formation of the nasolacrimal canal. If the cause of the chronic form is the deformation of the new cavity as a result of injury, the help of a maxillofacial surgeon is required.

The following methods are used for the treatment of newborns and infants:

probing of the nasolacrimal canal — used if the prenatal membrane itself has not resolved;
eye washing with special solutions;
massage for squeezing the contents out of the nasolacrimal canals. Often massage effectively removes the membrane that prevents the outflow of tears;

If conservative methods did not help after the age of three months, surgical intervention is possible to open the nasolacrimal canal.

It is very important to exclude mechanical irritation of the eyeball in dacryocystitis. If the patient has vision problems and wears contact lenses, it is necessary to abandon them for the duration of treatment and use glasses. Contact lenses irritate the already damaged mucous membrane of the eye, which can lead to a purulent process on the conjunctiva and injury.

Prevention of dacryocystitis

In order to exclude the possibility of dacryocystitis from your life, the following conditions should be observed:

timely and completely cure diseases of the nasal cavity and paranasal sinuses, such as sinusitis, rhinitis or nasal polyposis;
avoid traumatic effects on the nasal area and eyes;
in case of injuries, consult a doctor to eliminate the consequences;
avoid harmful conditions such as dusty rooms or exposure to harmful substances;
when working in harmful conditions (construction, chemical production), use protective equipment – special glasses and respirators;
avoid extreme temperatures (hypothermia or dry heat) for a long time;

In order to avoid the development of the disease, if you find yourself with one or more symptoms, you should definitely consult a doctor.