Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Dacryocystitis is an infection of the the tear bag of eye. This infection leads to consequent inflammation of the lacrimal sac.
It is derived from a Greek –
- Dakryo = tear
- Cysta = Sac
- Itis = Inflammation.
Dacryocystitis is secondary to naso-lacrimal duct obstruction – Along with the lacrimal sac (which is located near the nose end of the eye, medial angle or inner canthus) is attached a nasolacrimal duct (a tube like structure which carries the tears from the lacrimal sac to the nasal cavity). When this duct gets obstructed, dacryocystitis occurs. When the nasolacrimal duct obstruction is secondary to a congenital barrier, it is referred to as dacryocystocele. It is most commonly caused by Staphylococcus aureus and Streptococcus pneumonia infection.
When dacryocystitis is associated with Streptococcus pneumonia infection, the long-standing infection and consequent insult leads to corneal ulceration.
Ayurvedic Corelation of Dacryocystitis
A condition resembling Dacryocystitis has been explained in Ayurvedic texts in the name of Pooyalasa, in Netra Sandhigata Rogas (diseases occurring in the junctions of eye parts).
Related Reading – Puyalasa – Definition and meaning, location, symptoms, treatment
Signs and symptoms
Signs and Symptoms of Dacryocystitis
relaSymptoms and intensity vary from person to person.
Severe symptoms are often seen in the acute dacryocystits when compared to chronic condition (chronic dacryocystits).
Symptoms of acute and chronic dacryocystitis.
- Pain over the lacrimal sac at the medial canthus
- Swelling in the area of lacrimal sac
- Redness in the medial canthus (nasal side of the angle of the eye)
- Tearing (excess tears) – is a common complaint in dacryocystitis. But in chronic dacryocystitis, tearing may be the only complaint.
- Watery eye
- Pus and thick discharge from the eye – when pressure is exerted by a finger over the lacrimal sac, pus may extrude through the punctum
Causes and Pathophysiology (how dacryocystitis occurs)
Stasis and infection of nasolacrimal duct and lacrimal sac – The most important cause is the obstruction of the naso-lacrimal duct. This leads to the stasis of nasolacrimal fluid. This stasis predisposes to infection, most commonly by Staphylococcus aureus. This leads to infectious dacryocystitis.
Stones in lacrimal sac – In rare conditions stones may develop in the lacrimal gland, especially in the women. This will predispose to recurrent bouts of dacryocystitis. This is called acute dacryocystic retention syndrome.
Infection of structures surrounding the lacrimal sac – Dacryocystitis may also occur due to infection of surrounding structures, like pneumococcus infection of paranasal sinuses.
Congenital abnormality – In infancy, congenital abnormalities of the tear ducts, such as blockage in the tear ducts that runs to the nasal passages are common causes of dacryocystitis. This is called congenital dacryocystitis.
Causes of Dacryocystitis in older children and adults include –
- Nasal abscess
- Nasal polyps
- Foreign object in the duct
- Bacterial infections (as mentioned above)
- Trauma to the region that causes a blockage (injury to the nose, or eye, such as a broken bone)
- Tumors in the sinus or nasal passages
- Nasal or sinus surgery
Other risk factors –
- Deviated nasal septum
- Rhinitis (inflammation of nasal mucous membrane)
- Hypertrophy of inferior turbinate of the nose
Types of Dacryocystitis
Dacryocystitis can be acute or chronic.
Acute Dacryocystitis – Presents with sudden fever and pus from the eye. They are usually caused by bacterial infection. They respond to antibiotics and usually resolve within few days.
Chronic Dacryocystitis – In this, the onset of the symptoms is gradual. The symptoms are often less severe. Fever and pus may not be present (as in acute condition). There will be long lasting pain or discomfort in the medial canthus of the eye (angle of the eye, where two eyelids meet near the nose). It may be caused by an obstruction in the tear ducts. Surgery to widen the tear ducts may be needed to relieve the symptoms of chronic dacryocystitis, especially in severe manifestations.
Diagnosis of Dacryocystitis is usually done with the help of detailed medical history of the patient. The visible signs can be accessed by examining the eye wherein swelling and redness at the medial canthus is seen.
The doctor may press the lacrimal sac to see if pus comes out of the swelling. If pus comes out, the doctor may collect the sample of the pus to test for bacteria. This will help in accurate medication.
The doctor may also conduct a dye disappearance test. When yellow dye is put in the corner of the eye, it will disappear in few minutes in a healthy eye. If there is blockage in the lacrimal apparatus, the dye will linger in the eye for longer duration. The dye disappearance test will indicate whether the tear ducts are partially or entirely blocked.
Sometimes, imaging tests like CT scans are done to help the doctor look for the cause of the blockage
Chronic infection – An acute infection can become chronic if it is not treated properly. In babies with congenital dacryocystitis, the infection can spread into the eye socket. This can lead to life threatening complications such as –
- Brain abscess (pus formation and collection in the brain)
- Meningitis (inflammation of the membranes around the brain and spinal cord)
- Sepsis (inflammatory response caused due to infection in the entire body)
Generally the below mentioned strategies are followed in the treatment of dacryocystitis.
- Oral antibiotics (intravenous antibiotics in presence of severe symptoms)
- Eye drops (steroid eye drops in chronic dacryocystitis)
- Over-the-counter pain relievers and anti-inflammatory medications
- Warm compresses
- Relief of nasolacrimal duct obstruction by dacryocystorhinostomy (surgery to widen tear ducts or bypass the blockage)
Dacryocystits tends to recur often. About 60% of initial attacks of dacryocystitis will recur. Those people having poor immunity may develop orbital cellulitis. This may further lead to optic neuritis, proptosis, motility abnormalities or blindness.
Dacryocystitis is most common in infants. However adults over the age of 40 years also have a higher risk of developing dacryocystitis.
There are no strict guidelines for prevention of Dacryocystitis. But the below mentioned measures may help in prevention of recurrent or frequent infections of the tear duct leading to dacryocystitis.
- Avoid swimming in water containing chlorine (especially swimming pools)
- If there are frequent episodes of eye infections leading to dacryocystitis, future infections and recurrences can be avoided by undergoing a surgery called dacryocystorhinostomy which helps in widening the blocked lacrimal and nasolacrimal duct.
- If your tear ducts get frequently infected, one way to prevent them is to drain the rear sac. To do this, wash your hands thoroughly. Then hold a warm, wet washcloth over the tear sac. Carefully place your finger in the corner of your eye near your nose and apply pressure on the tear sac. Fluid or pus should release from the sac. Afterwards hold the warm compress to your eye yet again. This will prevent frequent infections.
Dacryocystitis may get chronic and produce serious symptoms and complications if the infection and inflammation is not treated promptly. Home remedies which have been given below are temporary remedies and may not cure your problems, especially if your dacryocystitis is of chronic and stubborn course. In spite of following the home remedies I would advice that you take the doctor’s opinion.
Remove gunk if any – In any eye infections (dacryocystitis here) if the eye (eyes) have become encrusted due to secretions (after closing the eyes for long period of time), the gunk should be removed gently. This enables easy opening of the eye (eyes). Take a clean washcloth. Immerse it in hot (tolerably) water. Wrung the cloth thoroughly to remove excess water and apply the cloth over the eyelashes. The heat and moisture in the cloth softens the crusts around the eyelashes which are preventing in opening of eyes. Once the crusts are soft, it can be easily wiped off with a clean tissue. If there is need of using the fingers near an infected eye make sure of washing your hands are thoroughly sanitized and washed before and after contact with the eye. Or else it is better to avoid fingers.
Warm Compress – Take a piece of fresh cloth. Plunge it in lukewarm water. Squeeze the cloth. Compress this cloth gently on the inflation on the eyes. This will provide relief to the eye.
Warm oil compress – Lukewarm compress of chamomile and rose oil are beneficial.
Herbal Eyewash – Pour 1 tablespoon of eyebright in 1 pint of boiling water and mix it properly. Let it cool. Filter the liquid. Store it in a covered container. This forms effective eyewash for your sore eyes.
Triphala Eyewash – Frequently wash your eyes with Triphala decoction or infusion (prepared from the three fruits of Terminalia chebula, Terminalia bellirica and Emblica officinalis), an Ayurvedic herbal preparation. This is the best proven time-tested remedy for eye disorders, inflammation and infections. This is called as Netra Prakshalana in Ayurveda. Stream pouring of decoction of Triphala in the eye or eyes for a fixed period can be done under supervision of an expert Ayurvedic doctor, this is called Netra Dhara.
Elderberry eyewash – Add 1 tsp dried elderberry blossoms in half cup water and prepare soothing eyewash.
Aloe vera eye soothe – Dip a clean cloth in Aloe vera juice. Put the cloth on your infected eyes. This soothes the eyes.
Tea Bags – Regular black or green tea bags that have been steeped in warm or cool water may help reduce swollen eyelids and redness of the eyes. The natural antioxidants and tannins in the tea may also provide some comfort from burning sensation and itching of eyes. Always make sure to test the heat of the teabags when using it warm or hot over the eyes.
Cold bread – Putting pieces of cold bread on your affected eyes gets rid of the inflammation and irritation.
Artificial tears – To flush out the foreign body from the infected eyes, moist your eyes with glycerin and then use the Aloe vera eyewash.
Antibacterial honey eyewash – pour 3 tbsp honey in two cups boiled water. Mix properly and let it cool. Apply this mixture as antibacterial eyewash.
Jasmine Drops – Take distilled water in a glass jar or bowl. Place 6-7 jasmine flowers in the water. Cover the jar (or bowl) and keep it overnight. Next day, apply few drops of that water with jasmine flower into your eyes. Keep doing it until your eyes are soaked with jasmine water. This can be repeated up to 2-3 times in a day.
Use of Amla and Triphala – Emblica officinalis and Triphala taken internally helps in healing eye infection related to dacryocystitis and also wards off the inflammation and associated symptoms. This also provides long standing immunity against eye disorders. Emblica officinalis (amalaki) should be taken in the form of powder or paste mixed with ghee or honey or both as per the direction of the consulting Ayurvedic physician. Triphala decoction taken with honey is very beneficial.
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