Chronic Dacryocystitis
Ophthalmology: Lacrimal Sac Inflammation
1. Pathophysiology
Chronic dacryocystitis is a persistent, low-grade infection of the lacrimal sac, almost always secondary to nasolacrimal duct obstruction (NLDO). Stasis of tears within the lacrimal sac provides an ideal medium for bacterial growth.
2. Clinical Features
| Sign/Symptom | Clinical Characteristic |
|---|---|
| Epiphora | Chronic tearing is the primary presenting complaint. |
| Regurgitation | Expression of mucoid or purulent material from the punctum upon pressure over the lacrimal sac area. |
| Swelling | Mild, non-tender or minimally tender fullness in the medial canthal region. |
3. Management & High-Yield Pearls
- Surgical Correction: Definitive treatment is Dacryocystorhinostomy (DCR), which creates a new drainage pathway between the lacrimal sac and the nasal cavity.
- Complications: Can progress to acute dacryocystitis (abscess formation) or cause chronic conjunctivitis; if surgery is planned, infection must be controlled pre-operatively.
- Red Flag: Always exclude lacrimal sac tumors in patients with a firm, irreducible mass, blood-stained discharge, or atypical clinical history.
- Educational Resource: For surgical checklists, DCR outcome metrics, and clinical practice questions, visit mymedschool.org.