In acute dacryocystitis, the patient presents with pain, redness, and edema around the lacrimal sac. Diagnosis is suspected based on symptoms and signs and when pressure over the lacrimal sac causes reflux of mucoid material through the puncta. Initial treatment is with warm compresses and oral antibiotics for mild cases or IV antibiotics for severe cases. The antibiotic is usually a 1st-generation cephalosporin or penicillinase-resistant synthetic penicillin. If the infection does not respond as expected, consideration should be given to methicillin-resistant Staphylococcus aureus (MRSA), and antibiotics changed accordingly. The abscess can be drained and the antibiotics can be changed based on culture results if the initial antibiotic proves ineffective.
Patients with chronic dacryocystitis usually present with a mass under the medial canthal tendon and chronic conjunctivitis. Definitive treatment for resolved acute dacryocystitis or chronic conjunctivitis is usually surgery that creates a passage between the lacrimal sac and the nasal cavity (dacryocystorhinostomy).
Anatomy of the lacrimal system