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dacryocystitis Case

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Lacrimal Sac Lesion

Case Presentation

A 60-year-old woman complained of tearing and pain in her right eye. She had no history of trauma or surgery of the eyelids, nose or sinuses. She had tearing and discharge for several months. Recently she had developed a painful red lump near the right inner canthus. Examination showed her vision to be 6/6 OU. There was an erythematous swelling over the right lacrimal sac.

Lacrimal Sac Lesion

Evaluation and Management

Discharge from punctum

Reg Test

Probing / Irrigation

Investigations

  1. Reg test
  2. Probing / Irrigation only to adults. Giving saline may aggravate the condition in children.
  3. Fluorescent stain test

Treatment

  • Adult: Probing and silicon tube in case of partial obstruction.
  • In total obstruction – DCR (Dacryocystorhinostomy).
  • Children:
    • Less than 1 year – conservative treatment (ocular massage, topical antibiotic, hot compress) – after 1 year we can do probing twice.

Clinical Features of Lacrimal Sac Lesion

  • Tearing
  • Discharge
  • Tender
  • Sex

Diagnosis of Lacrimal Sac Lesion

Chronic Dacryocystitis (Mucocele)

Further Evaluation

  • Other causes of tearing
  • Examination and testing
  • ?? Probing
  • CT
  • Dacryocystography

Differential Diagnosis of Lacrimal Sac Lesion

  • Dacrocystocele
  • Preseptal cellulitis
  • Acute ethmoid sinusitis
  • Frontal sinusitis

Treatment of Lacrimal Sac Lesion

  • Acute dacryocystitis

    • Start broad‐spectrum systemic antibiotics (e.g. cephalosporin or amoxicillin-clavulanate).

    • Apply warm compresses.

    • If an abscess forms, perform incision and drainage.

    • Once infection subsides (typically 1–2 weeks), plan definitive surgery (see below).

  • Chronic nasolacrimal obstruction

    • Definitive treatment is dacryocystorhinostomy (DCR)—either external or endoscopic.

    • Silicon tube intubation may be added to stent the new passage for 2–3 months.

  • Suspected lacrimal-sac tumor or atypical lesion

    • Obtain imaging (CT/MRI) to assess extent.

    • Biopsy or excisional biopsy via external DCR approach, ensuring clear margins.

    • Adjuvant radiotherapy or chemotherapy if malignant (e.g. squamous-cell carcinoma, melanoma).

  • Congenital lacrimal-sac cyst (dacryocystocele)

    • Initial massage of lacrimal sac (“Crigler’s maneuver”).

    • If persistent or infected, probing of the nasolacrimal duct ± endoscopic marsupialization.

Graph View

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