The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Dacryocystitis is an acute bacterial infection of lacrimal sac, usually secondary to blockage of the nasolacrimal duct. It is most common in neonates and adults, especially females, aged over 40. Paediatric dacryocystitismay be associated with dacryocoele, which tends to progress rapidly to lacrimal abscess, and if untreated can cause vision-and life-threatening complications such as orbital cellulitis, orbital abscess and meningitis. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating dacryocystitis. It provides recommendations for non-pharmacological management and pharmacological treatment, and highlights when emergency referral is required.
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What is acute dacryocystitis?
Dacryocystitis means infection of the tear sac, the small chamber in which the tear fluid collects as it drains from the eye surface, which is 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. It starts suddenly with pain and tenderness over the tear sac and the patient may quickly develop a raised temperature. The infection may also cause conjunctivitis (infection of the transparent membrane over the white of the eye) and cellulitis (infection of the soft tissues surrounding the eye). Sometimes the sac bursts, releasing pus on to the skin surface.
How is dacryocystitis managed?
It is important to try to distinguish between this condition and a serious infection of the eye socket (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.