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Dacryocystitis

Signs and Symptoms:
Dacryocystitis occurs most often in infants, and although it more commonly appears in one eye, it can occur in both. The main symptoms are excessive tearing or watering of the eye, even when the child is not crying (this is called epiphora). The tearing is usually accompanied by redness at the inner corner of the eye and mild tenderness and a swelling or bump at the side of the nose. Left untreated, this redness may spread to other parts of the face. These symptoms may also be accompanied by a fever.

Another symptom of dacryocystitis is pus or mucus that collects in the corner of the eye. This may cause your child to wake up with a crusting over the eyelid or in the eyelashes.

If the infection is mild and left untreated, most of the symptoms may disappear, with the exception of some swelling. Fluid retention caused by the infection may cause a large fluid-filled sac called a mucocele to form under the skin. In severe cases, this can cause an abscess that needs to be drained surgically.

Description:
The eyes are continually bathed in protective tears, which cleanse, protect, and lubricate the eye before draining into the nose.

Dacryocystitis is an infection of the lacrimal sac. This small sac sits at the inner corner of the eye; tears drain into it from the eye and then pass through the nasolacrimal ducts (often referred to as tear ducts) and into the nose.

The infection is usually caused by blocked nasolacrimal ducts (also called dacryostenosis), a congenital (present from birth) condition occurring in up to one third of newborns. In children who have dacryocystitis, tears are unable to drain from the lacrimal sac, so they pool in the eye and allow bacteria to grow, leading to infection. Dacryocystitis is treated with antibiotic eye drops or ointment and oral or intravenous antibiotics if necessary.

Although blocked tear ducts will often disappear without treatment as a child grows, if your child has dacryocystitis, especially if it occurs more than once, your child's eye doctor may want to do a surgical probe and irrigation (flushing) to open the tear ducts and allow them to drain properly. The younger your child is, the more likely the doctor is to recommend the surgical probe, as the failure rate for this procedure increases once your child is past 1 year of age.

In rare cases, dacryocystitis occurs in older children. In these cases, blockage of the tear duct may be caused by cysts (also called nasal polyps) or a tumor in the nose at the end of the tear duct. A lacerated tear duct caused by trauma to the eye area could also lead to an obstruction, but in most instances, surgical reconstruction at the time of the trauma would prevent tear-duct obstruction.

Duration:
Once you start treating your child with antibiotics, it can take a week or 2 for the infection to clear, but you should follow up with your child's doctor to make sure it's gone. If it doesn't go away or is a recurring problem, surgery may be necessary to remove the obstruction.

Contagiousness:
Dacryocystitis is not contagious.

Prevention:
In children with blocked tear ducts, dacryocystitis may be prevented with regular massage of the eye area, which may help to open the blockage of the tear ducts. Most children's tear ducts open by the time they're 1 year old, which prevents excessive tearing, as well as the infection.

When to Call Your Child's Doctor:
If your child has excessive tearing but shows no sign of infection, consult with your child's doctor or a pediatric ophthalmologist to see if the cause is a blocked tear duct - early treatment can prevent the need for surgery.

If signs of infection (such as redness, pus, or swelling) are present, call your child's doctor immediately because the infection can spread to other parts of the face or lead to an abscess (walled-off collection of pus) if left untreated.

Professional Treatment:
If signs of infection are present, your child's doctor may use a cotton swab to obtain a culture from your child's eye. This can help to distinguish dacryocystitis from other common eye infections such as conjunctivitis. More commonly, however, the doctor will be able to diagnose dacryocystitis based on your child's symptoms and will prescribe antibiotic drops or ointment without taking a culture.

In cases of severe infection, your child may be admitted to the hospital and given antibiotics intravenously. It's important to remember that antibiotics do not get rid of an obstruction to the tear duct; they only treat the resulting infection.

Once the infection has cleared, your child's doctor may ask you to perform daily massage of the tear duct in order to try to remove the obstruction. However, if your child suffers from a severe infection or the infection recurs past the age of 6 to 8 months, your child's doctor may recommend an evaluation by a pediatric ophthalmologist to see if your child needs a surgical probe to open the blocked tear duct. If a surgical probe is not successful, your child may need further surgery.

Home Treatment:
If you suspect an infection, call your child's doctor. He or she may give you antibiotic ointment or drops to put in your child's eye several times a day. If your child is uncomfortable, warm compresses applied to the eye may help relieve pain and promote drainage. For pain relief, you can also give your child children's acetaminophen or ibuprofen as recommended by the doctor. Limit your child's activities until she's feeling better - this may take a couple of days after the antibiotic treatment is started.

Once the infection has cleared, your child's doctor may ask you to massage the tear duct daily. After washing your hands, place your index finger on the side of your child's nose at the inner corner of the affected eye and firmly massage down toward the corner of the nose on that side. In many cases, the pressure of daily massages will eventually open the tear duct.

If your child has a surgical probe and irrigation, it may take a few days or a week to notice improvement. Your child's doctor will give you instructions on how to care for your child after this procedure.

Reviewed by: Sharon Lehman, MD
Date reviewed: May 2000
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