CLINICAL MANAGEMENT GUIDELINES
Dacryocystitis (acute)
Aetiology
Predisposing
factors
Symptoms
Signs
Bacterial infection of lacrimal sac
Usually secondary to blockage of nasolacrimal duct.
Commonest in infants and post-menopausal women
Relatively rare in older children
Infection may be due to Gram positive or Gram-negative
organisms. Staphylococcus aureus and Streptococcus
pneumoniae are the most common isolates amongst Gram-positive
bacteria and Haemophilus influenzae, Serratia marcescens and
Pseudomonas aeruginosa amongst Gram-negative bacteria
Maxillary sinusitis
Trauma to adjacent tissues
Nasal or sinus surgery
Congenital obstruction of nasolacrimal duct (see Clinical Management
Guideline on NLD Obstruction)
Sudden onset
Pain
Tender swelling over lacrimal sac (anatomically located just
below the medial palpebral ligament)
Epiphora
Fever (raised temperature)
Red, tender swelling centred over lacrimal sac and extending
around the orbit
Purulent discharge expressible from one or both puncta when
pressure is applied over the lacrimal sac (NB likely to be
painful for patient)
Sac may discharge on to skin surface
(NB important to distinguish between acute dacryocystitis, in which
sac is full of pus, and mucocoele in which sac is filled with mucoid
material in the absence of infection)
Frequently, patients may present with conjunctivitis and preseptal
cellulitis. Rarely, the infection extends beyond the septum, and
causes orbital cellulitis
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Dacryocystitis (acute)
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CLINICAL MANAGEMENT GUIDELINES
Dacryocystitis (acute)
Differential
diagnosis
Facial cellulitis, preseptal cellulitis, orbital cellulitis (check ocular
motility and look for proptosis) (Refer to Clinical Management
Guideline on Cellulitis [preseptal and orbital])
Acute frontal sinusitis (inflammation involves the upper eyelid)
Infection following superficial trauma/abrasion of skin
Management by Optometrist
Practitioners should recognise their limitations and where necessary seek further advice or
refer the patient elsewhere
Non pharmacological Do not attempt to probe the lacrimal system during acute
infection (risk of spreading infection)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Pharmacological
Topical antibiotic to prevent bacterial conjunctivitis: e.g.
chloramphenicol
drops and/or ointment for not less than 5 days
For mild and non-febrile cases, consider prescribing systemic
antibiotic, e.g. co-amoxiclav or, where there is a penicillin allergy,
erythromycin
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
A2: for severe cases and in all children, give first aid measures
and refer as emergency (same day) to Ophthalmologist or A&E
Department. Cases are severe if patient is febrile and/or
systemically unwell or if an abscess has developed (i.e. pointing on
surface)
A3 (modified as condition not sight-threatening): for milder cases
not responsive to systemic antibiotic, refer urgently (within one
week) to ophthalmologist
B3: management to resolution
After acute infection has been controlled there may be an
obstruction of the nasolacrimal drainage system (see Clinical
Management Guideline on Dacryocystitis [chronic])
Possible management by Ophthalmologist
Incision and drainage where appropriate
Management
Category
Dacryocystitis (acute)
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Date of search 22.05.15; Date of revision 27.05.15; Date of publication ab.cd.ef; Date for review 21.05.17
© College of Optometrists
CLINICAL MANAGEMENT GUIDELINES
Dacryocystitis (acute)
Systemic antibiotics
Follow-up may include investigation and surgical intervention for
nasolacrimal duct obstruction
Evidence base
*GRADE: Grading of Recommendations Assessment,
Development and Evaluation (see
http://gradeworkinggroup.org/toolbox/index.htm)
Sources of evidence
Pinar-Sueiro S, Sota M, Lerchundi TX, Gibelalde A, Berasategui B,
Vilar B, Hernandez JL. Dacryocystitis: Systematic Approach to
Diagnosis and Therapy. Curr Infect Dis Rep. 2012 Jan 29. [Epub
ahead of print]
LAY SUMMARY
Dacrocystitis means inflammation of the tear sac, which is situated beneath the skin alongside the inner corner of the eye. It is commonest in infants
and middle-aged women and is usually caused by an infection by commonly occurring bacteria (germs). It starts suddenly with pain and tenderness
over the tear sac and the patient may quickly develop a fever (raised temperature). The infection may also cause conjunctivitis (infection of the white
skin of the eye) and cellulitis (infection of the soft tissues surrounding the eye). Sometimes the sac bursts, releasing pus on to the skin surface.
It is important to try to distinguish between this condition and orbital cellulitis itself, especially in children, who should be referred to hospital the same
day for emergency treatment. Treatment includes antibiotics, which may have to be given via a needle into a vein, and surgery to encourage pus
from the infection to drain away.
Dacryocystitis (acute)
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Date of search 22.05.15; Date of revision 27.05.15; Date of publication ab.cd.ef; Date for review 21.05.17
© College of Optometrists