Introduction – Lacrimal sac inflammation
Lacrimal sac inflammation (dacryocystitis) is defined as an acute or chronic inflammation of the lacrimal sacs, which are part of the so-called draining lacrimal ducts. The lacrimal sac is located under the skin in a small groove in the bone at the inner corner of the eyelid. People of all ages can be affected.
Especially small children, as their tear ducts may not yet be fully developed. The same applies to older people, as they may not produce enough tears. The signs of acute lacrimal sac inflammation are those of localized inflammation in general.
This includes swelling and redness, which can also spread to surrounding structures such as the conjunctiva and lower eyelid. In addition, pain usually occurs, which can also radiate over the local inflammation area, e.g. in the cheek area. Pus can form, which can already be visible at the inner corner of the eyelid, or it can empty after gentle pressure on the lacrimal sac.
Chronic lachrymal sac inflammation often occurs in older patients who have recurrent inflammation (so-called relapses). Then the symptoms can also be less pronounced, as the body’s reaction is less intense. In addition, severe courses of the disease can lead to symptoms of a flu-like infection such as fever or chills.
At the latest then a doctor should be consulted urgently. This is usually clear due to the localization and nature of the symptoms. In addition, the treating physician should also clarify the possible involvement of other structures such as the sinuses.
In order to be able to apply a sensible antiobiotic therapy, a smear should also be taken to identify the type of bacteria. This usually involves a procedure appropriate to the severity of the inflammation and the patient’s age. In about half of the cases no antibiotic administration is necessary or can be waited until 3 days after the onset of symptoms.
In infants and toddlers, it is advisable to wait until the Hasner valve has opened. In adults, decongestant eye ointments or drops can be administered. In addition, moist compresses with disinfecting properties can support the natural healing process.
In severe or prolonged cases, antibiotic therapy should be started after an appropriate antiobiogram (antibiotic sensitivity of the identified bacterial species). If necessary, the tear ducts can also be rinsed with physiological saline solution under local anaesthesia by a doctor. If the conventional forms of therapy are not effective enough, an operation may be advisable.
This is also called dakyrocystorhinostomy and can be performed in two ways. Either the lacrimal sac inside the nose itself is opened using a thin-caliber endoscope, or a connection from the lacrimal sac to the nose is artificially placed from the outside. In most cases, the cause is an obstruction (stenosis) in the drainage of the lacrimal ducts at the exit of the lacrimal sac or in the more deeply located nasolacrimal duct.
In medical jargon, this is called the nasolacrimal duct. It leads the tear fluid from the lacrimal sac into the nose where it can evaporate due to breathing. A special case of the flow obstruction affects infants affected by lachrymal sac inflammation.
The exit of the nasolacrimal duct is still closed by the Hasner valve. This usually opens spontaneously, but not in the affected infants. This leads to a backlog of tear fluid and thus usually to inflammation.
This obstruction of the outflow alone would not lead to an inflammatory reaction of the body, but the subsequent infection by pathogenic microorganisms is the cause. These microorganisms have usually risen from neighbouring structures such as the nasal cavity or paranasal sinuses and, thanks to the stagnant flow of tear fluid, find a rich breeding ground for their growth. Mostly these are bacteria of the species Stapylococcus aureus or pneumococcus, but fungi can also penetrate the lacrimal sac and cause inflammation.
The introduction of dirt particles into the lacrimal ducts by rubbing the eyes of small children can also promote infection. Therefore, careful hygiene should be paid attention to in order to effectively prevent infections. A large proportion of lacrimal sac infections are idiopathic, i.e. the causes are unclear.In the other cases, underlying diseases such as sicca syndrome should be treated, as dry eyes and the resulting lack of tear fluid flow through the lacrimal ducts are a good possibility for infectious pathogens. As with all diseases caused by bacteria or viruses, careful hygiene should be observed to reduce the likelihood of infection.
