Dacryocystitis - The Tear Duct That Cannot Cry

The apparatus for creating and draining of the tears from our eyes consists of a tear sac or lacrimal sac, little tube-like canaliculi, and the nasolacrimal duct. The tears drain into little opening situated at the inner corner of the eyelid, called puncta, from there they travel through the canaliculi to the tear sac and finally taken to the nose by the nasolacrimal duct. Dacryocystitis is a condition where the tear sac gets inflamed and consequently blocked.

It is usually caused by the blockage of nastolacrimal duct, thus stopping the passage of excess tears into the nose. This flow of tears from eyes to nose is needed to get rid of the excessive tears; and that is why we do have to blow our nose while we are crying aloud. When the draining gets blocked, the accumulated tears provide a suitable medium for the bacteria to grow, adding a bacterial infection to the earlier inflammatory response.

There are cases presenting with failure of the nasolacrimal duct to open on its own in the infantile stage, a condition called dacryostenosis. Like infants, it gets more common in the elderly or adults who are above 40 yrs of age. In adults, it is usually associated with inflammation and/or infection in the nasal region. It can be acute with sudden onset, or it can be long-standing with the symptoms occurring over the course of weeks or months.

The presenting symptoms are pain in the region of orbit with other inflammatory manifestations like redness, and swelling. The area looks swollen and shiny due to stretching of the delicate skin around the eyes. A gentle pressure over the swollen area can lead to a purulent discharge from the punctum. It is usually unilateral, that is occurring in single eye at a time. The eye looks watery.

Diagnosis can be made clinically through signs and symptoms. It can also be supported with lab tests where the white blood cell count is raised indicating acute infective origin [which is mostly normal in case of chronic variant]. In some cases, a procedure called dacryocystography can be done to locate the blockage area, by injecting a radio-opaque dye into the duct.

Treatment includes warm compress and antibiotics. Homeopathic medicines like Belladona, Apis and Arsenic have shown remarkable effect on this particular ailment. Surgical procedures are often required to release the blockage of the duct, in case the patient does not respond well to the medication.