Dacryocystitis is an infection of the tear sac, which sits between the inner corner of the eye and the nose, almost always because the tear duct below it is blocked. Tears stagnate, bacteria such as Staphylococcus and Streptococcus grow, and the infection can spread to the tissues around the eye.
Key symptoms
- Painful, red swelling just below the inner corner of the eye
- Constant tearing from that eye
- Discharge from the inner corner
- Fever in more severe cases
What you find on exam
- Tender swelling over the tear sac, beside the nose
- Gentle pressure on the sac may push pus out of the tear duct openings
- Vision, eye movements and pupils to rule out orbital cellulitis
- Look for spreading redness of the eyelids and cheek
Tests
- Culture of the expressed pus
- CT of the orbits if there is proptosis, painful eye movements or vision changes
- Blood count and blood cultures if febrile and ill
Treatment basics
- Oral antibiotics such as amoxicillin-clavulanate or cephalexin; add MRSA coverage if at risk
- IV antibiotics if severe, in ill children or with orbital spread
- Warm compresses
- Do not probe the duct during acute infection
- Refer for drainage of an abscess and later dacryocystorhinostomy to fix the blockage
Red flags
- Proptosis, painful or limited eye movements
- Decreased vision
- High fever, toxic appearance or spreading facial cellulitis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.