Dacryocystitis is an infected lacrimal sac inflammation which in some cases leads to an abscess forming. Most commonly caused by staphylococcal and streptococcal pathogens, typically due to nasolacrimeal canal obstruction.
Pain, redness, and swelling around the lacrimal sac are signs of acute dacryocystitis. The diagnosis is made on the basis of symptoms and signs, including the presence of purulent discharge reflux from the lacrimal opening when the lacrimal sac area is pressed. The main care consists of warm compresses, oral intake of antibiotics in moderate cases and intravenously in extreme cases. As an antibiotic treatment, first-generation cephalosporine or penicillinase-resistant synthetic penicillin is typically chosen. If they are ineffective, you can suspect infection of the lacrimal sac with methicillin-resistant Staphylococcus aureus (MRSA) and it is necessary to change the treatment regimen. If the drug of choice is ineffective, based on the results of a culture study, drainage of the abscess and antibiotic replacement can be performed.
Chronic dacryocystitis patients typically have a structure under the medial eyelid commissure and chronic conjunctivitis. An procedure that produces an external message between the lacrimal sac and the nasal cavity (dacryocystorhinostomy, DCR) is the most effective treatment for completed acute dacryocystitis or chronic conjunctivitis.
To determine the type of pathogens, a complete ophthalmic examination and, where possible, bacteriological culture obtained from the lacrimal canal is needed. Effective medication is recommended depending upon the signs and nature of the disease.
Antibiotic treatment is regulated according to the clinical response and the results of bacteriological culture:
- Eye drops with antibiotics;
- Warm compresses and gentle massage on the inner edge of the eyelid;
- Painkillers as needed;
- An incision and drainage to assess abscess, which should always be performed by a specialist.
Once the acute process subsides, surgical treatment can be considered, especially in cases of chronic dacryocystitis. This is the only way to treat this disease in the chronic stage, and if left untreated, episodes of infection may recur.
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