Definition
A.Infection or inflammation of the lacrimal sac, or dacryocystitis, can be acute or chronic. Dacryocystitis is more common in children than in adults.
B.Dacryocystitis is usually secondary to obstruction of the nasolacrimal duct.
Incidence
A.The incidence is unknown in adults.
B.In adults, dacryocystitis is more common in females and after age 40.
Pathogenesis
A.Bacterial infection of the lacrimal sac usually is caused by Staphylococcus, Streptococcus, Haemophilus, and Pseudomonas. Methicillin-resistant Staphylococcus aureus is more common in acute dacryocystitis.
Predisposing Factors
A.Nasal trauma.
B.Deviated septum.
C.Nasal polyps.
D.Congenital dacryostenosis.
E.Inferior turbinates.
Common Complaints
A.Pain in the eye.
B.Redness.
C.Swelling.
D.Fever.
E.Tearing.
F.Visual change.
Other Signs and Symptoms
A.Purulent exudate may be expressed from the lacrimal duct.
Subjective Data
A.Elicit the onset, course, and duration of symptoms. Are symptoms bilateral or unilateral?
B.Review the patient’s activity when the symptoms began to determine if etiology is chemical, traumatic, or infectious.
C.Review other presenting symptoms such as fever and discharge.
D.Review the patient’s history for previous episodes. Note treatments used in the past.
E.Review history for a recent herpes simplex virus (HSV) or fever blister.
F.Review ophthalmologic history.
G.Review medications.
H.Review blood glucose in diabetics.
Physical Examination
A.Check temperature, pulse, and blood pressure.
B.Inspect:
1.Assess both eyes.
2.Check peripheral fields of vision and sclera.
3.Evaluate conjunctiva for distribution of redness, ciliary flush, and foreign bodies.
4.Inspect lid margins: Evaluate for crusting, ulceration, and masses.
C.Palpate:
1.Palpate lacrimal duct and surrounding bony structures. Discharge can be expressed from the tear duct with the application of pressure.
Diagnostic Tests
A.Check visual acuity.
B.Culture discharge.
C.Plain radiographs if foreign body is suspected.
D.CT to evaluate trauma, suspected tumor, and orbital cellulitis.
Differential Diagnoses
A.Dacryocystitis.
B.Chalazion.
C.Blepharitis.
D.Xanthoma.
E.Bacterial conjunctivitis.
F.Hordeolum.
G.Foreign body.
H.Orbital cellulitis.
I.Preseptal cellulitis.
Plan
A.General interventions:
1.Apply warm, moist compresses at least four times per day.
2.Instruct female patients to discard old makeup, including mascara, eyeliner, and eye shadow used prior to infection.
B.Patient teaching:
1.Advise patient to perform proper handwashing and cleaning.
2. 
See Section III: Patient Teaching Guide How to Administer Eye Medications.
C.Pharmaceutical therapy:
1.Acute dacryocysitis clindamycin 300 mg q6h for 7 to 10 days depending on response.
2.Acute dacryocystitis with orbital cellulitis requires hospitalization with intravenous (IV) antibiotics.
Follow-Up
A.Follow-up in 3 days for reevaluation.
Consultation/Referral
A.Acute dacryocystitis: Abrupt onset with erythema, warmth, swelling, and pain of the lacrimal duct should be managed on the same day by an ophthalmologist.
B.Chronic dacryocystitis: Refer the patient to an ophthalmologist for irrigation and probing if needed.
C.Lab studies are generally performed by an ophthalmologist.
Individual Considerations
A.Adults/Geriatrics:
1.Referral to ophthalmologist for acute and chronic condition.