Acute dacryocystitis is an inflammation of the lacrimal sac, usually caused by nasolacrimal duct obstruction. Symptoms include painful swelling near the inner corner of the eye, tearing, discharge or fever. On examination, the swelling is reddish and tender. Treatment involves hot compresses, antibiotics, and surgery such as dacryocystorhinostomy to bypass an obstruction if inflammation persists or complications like abscess or fistula occur.

1. Acute Dacryocystitis
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2. Anatomy of Lacrimal System
 Lacrimal system consist of ;
1. Secretory System: Secretes tears.
 Main Lacrimal Gland
 Accessory Lacrimal Glands
2. Excretory System: Drains tear.
• Lacrimal puncta
• Lacrimal canaliculi
• Lacrimal sac
• Nasolacrimal duct

3. Lacrimal Glands
 Main Lacrimal Gland:
• These are the serous glands situated at
the upper and outer angle of orbit, in a
depression in frontal bone known as
‘fossa for the lacrimal gland’.
• Each gland is approximately the size and
shape of an almond.
• Main lacrimal gland have a superior or
orbital lobe and inferior or palpebral
lobe.

4.  Accessory Gland
• Gland of Krause: They are about
20 in number in upper lid and
about 8 in lower lid situated within
the stroma of the conjunctiva
mainly near the fornix.
• Glands of Wolfring: These are few
number situated near the upper
border of tarsal plate.

6. Secretory System
 Lacrimal puncta
 Lacrimal canaliculi
 Lacrimal sac
 Nasolacrimal duct

8. Acute Dacryocystitis
 It is the acute inflammation of
lacrimal sac.
 It is characterized by presence of
painful swelling in the region of
sac.
 Swelling in dacryocystitis is below
the medial canthal tendon.
Lacrimal sac tumor (rare) is
suspected if mass is above the
medial canthal tendon.

9. Aetiology
 De novo.
 Almost always related to nasolacrimal duct
obstruction.
 Gram- positive bacteria are the most common
pathogens; however, gram- negative and atypical
organism are seen more commonly in diabetics,
immunocompromised, and nursing home patients.

10. Clinical Features
Symptoms
 Subacute onset of painful
redness.
 Swelling at the medial canthus
associated with epiphora.
 Tearing, discharge or fever.

11. On Examination
 Swelling at medial canthus, which is reddish and
tender on touch.
 Regurgitation test is difficult to perform because of
tenderness.
 Mucopurulent or purulent discharge may be present
on the side of medial canthus.
 Abscess formation may occur in untreated cases.
 Abscess may rupture and pus comes out.

12. Complications
• Corneal ulcer, osteomyelitis of the lacrimal bone
and orbital and facial cellulitis may develop as
complications of acute dacryocystitis.
• External fistula formation.

13. Treatment
Conservative
 Hot compresses, systemic broad spectrum antibiotics, analgesics and
anti-inflammatory drugs are effective.
Surgical
 In case of lacrimal abscess, a vertical incision is given over the sac area
in the lower part to facilitate the drainage by gravity.
 In case of lacrimal fistula, excision of fistulous tract and removal of sac
is done.
 Dacryocystorhinostomy (DCR) operation is performed when acute
inflammation has settled, and there is persistent epiphora.
 In DCR an anastomosis is created between the sac and the nasal
mucosa to bypass an obstruction in the nasolacrimal duct.