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.
Chronic dacryocystitis is an infection or inflammation of the lacrimal sac that occurs secondary to chronic nasolacrimal obstruction. It can present as recurrent episodes of conjunctival hyperaemia and epiphora, lacrimal sac mucocoele and chronic conjunctivitis with erythema of the lacrimal sac. This Clinical Management Guideline outlines the aetiology, signs, symptoms and evidence-based recommendations for diagnosing and treating chronic dacryocystitis. This includes non-pharmacological and pharmacological treatment, and outlines when referral for possible surgery may be appropriate.
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What is chronic dacryocystitis?
Chronic dacrocystitis means a low-grade infection or inflammation 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 at the inner corner of the eye. It can result from a previous acute infection and from blockage of the tear duct leading from the tear sac to the inside of the nose. Finger pressure over the sac sometimes causes white mucus to appear at the openings of the tear passages at the inner corners of the eyelids; this may help in reaching a diagnosis. Patients usually complain of swelling and sometimes tenderness over the tear sac, plus watering of the eye.
How is chronic dacryocystitis managed?
If the condition results in repeated episodes of acute infection, antibiotics are given, as eye drops. In less acute cases, hot compresses and massage over the tear sac may relieve the patient’s symptoms. A special test known as dacryocystography may help to show exactly where the tear duct blockage is, and this will help the eye surgeon to decide on whether surgery is necessary, and if so, of what kind. In a commonly performed operation known as a dacryocystorhinostomy or DCR, a new passage is created from the tear sac into the inner wall of the nose, so that the tears can drain directly without having to pass down the tear duct.