Good Hope, Heartlands, and Solihull Eye Clinics

Acute dacrocystitis (infected tear sac)

David Kinshuck

 

Reduced drainage of tears

Blocked naso-lacrimal duct

If the tear passages near the nose block, you may notice both

The tear duct apparatus may block at any point along the tear passage, but the commonest place for a blockage is just below the tear sac. The cause of this blockage is not usually known.

The treatment that the doctor will recommend depends on how much the watery eye bothers you, and whether you find it very uncomfortable, or just a nuisance in the wind.

a blocked tear duct...between the eye and the nose

naso-lacrimal duct occlusion...one cause of watery eyes

 

Infection of the tear sac (acute dacrocystitis)

acute dacrocystitis ...an acute infection of the lacrimal sac

an infected nasolacrimal sac..a tender lump on the size of the nose

A few people with a blocked tear duct can develop an infection in the tear sac. This is quite uncomfortable, just like an abscess anywhere else in the body.

It is called 'acute dacrocystitis'. This begins as a blocked tear duct and watery eye. The tears then get trapped in the tear sac, and stagnate.

The stale tears may then become prone to infections.If you develop an infection in the tear sac,  like any other abscess under the skin, you need treatment, as below.

See

 

The treatment for an infection of the tear sac.

  1. Bathe the 'abscess' with a hot flannel four times a day.
  2. See your GP for antibiotics
    • co-amoxyclav 625mg three times a day 1 week if you are not allergic to penicillin
    • Clarithromycin¬†¬† 500mg twice daily 1 week if you are allergic to penicillin
  3. If the abscess is rather severe you need to attend an Eye Emergency Department: sometimes the abscess needs draining.

After the infection.

After the attack of dacrocystitis and all the infection has gone, the tears ducts may be open. However, the infection may damage the tear drainage, and the eyes may be watery. In this case a DCR operation is necessary after you have had acute dacrocystitis. The operation is carried out when the infection has been treated.
Anyone with more than one episode of infection needs a DCR operation unless there are contraindications (they are ill etc).

 

Treatment

DCR Operation: the operation to open the duct at the lower end

If the nasolacrimal duct is blocked, and if you are young or middle aged, and your eyes water and are uncomfortable much of the time, an operation can be helpful. Such patients would notice watery eyes at least 10 times a day.

a DCR operation creates a channel from the tear sac into the nose

DCR surgery

This operation generally requires a general anaesthetic and an overnight stay in hospital. This is a 'DCR' operation, which translates into 'making a channel from the tear sac into the nose'.

One common operation is a  cut on the skin over the tear sac, and then a small hole made in the bone between the tear sac and the nose. Next the surgeon connects the tear sac to the inside of the nose, and closes the cut in the skin. The skin scar fades and is usually nearly invisible after six months.

There are other types of operation, such as using balloons that can be blown up to expand the blocked tear duct. These may not be quite as successful, and are only available in a few hospitals. Alternatively the DCR operation can be carried out by using special instruments 'up the nose'.

Instructions after surgery. Leaflet DCRs operation

 

Frail people or no operation

If you are frail this operation is not generally recommended unless you have developed infections of the tear sac, as below. Even if you are well, if your watery eye is not really bothersome, you may prefer to manage as you are without having an operation. You may notice a small lump under the skin: the swollen tear sac. Unless there is an infection, you hardly feel the lump at all.

These is no harm in having watery eyes.