Dacrocystitis, Dacryostenosis, Dacryocystocoele

Dacrocystitis

• Cause: Infection of a nasolacrimal duct obstruction (commonly Staphylococcus aureus, Streptococcus pneumoniae).

• Features:

  • Painful, red swelling at the medial canthus

  • Epiphora (tearing), purulent punctal discharge

  • Possible fever in severe cases

• Management:

  • Warm compresses, gentle lacrimal sac massage

  • Oral antibiotics (e.g. cephalexin 500 mg QID for 7 days; weight-based dosing in children)

  • Abscess formation → Refer for incision and drainage

  • Urgent referral if worsening infection or signs of orbital cellulitis (proptosis, diplopia)

Dacryostenosis (Congenital Nasolacrimal Duct Obstruction)

• Cause: Failure of distal nasolacrimal duct to canalise in infants

• Features:

  • Epiphora, crusting around eyelids

  • Typically no swelling or erythema

• Management:

  • Lacrimal sac massage (downward strokes), warm compresses

  • Topical antibiotics only if secondary infection

  • Persistent obstruction beyond 12 months → Refer for probing under anaesthesia

  • Most cases resolve spontaneously by age 1 year

Dacryocystocoele

• Cause: Obstruction at both ends of the nasolacrimal duct leading to fluid accumulation and cyst formation

• Features:

  • Firm, bluish, cystic swelling at the medial canthus (noted in neonates)

  • Possible nasal obstruction or respiratory distress in infants

• Management:

  • Urgent referral due to high risk of infection or progression to orbital cellulitis

  • Definitive treatment may involve surgical decompression or marsupialisation

Notes

• Red Flags: Fever, periorbital erythema, proptosis → potential orbital cellulitis → immediate referral

• Adults: Recurrent dacrocystitis may require dacryocystorhinostomy (DCR)

• Follow-up is essential to ensure resolution and to prevent complications (e.g. meningitis, sepsis)