Dacryocystitis

Excerpt

Dacryocystitis is the most commonly encountered disease of the lacrimal drainage system. This disease is an inflammation of the lacrimal sac, typically caused by an obstruction of the nasolacrimal duct (NLD), leading to the stagnation of tears in the lacrimal sac. Dacryocystitis patients complain of watering from the affected eye and distension of the lacrimal sac, visible below the medial canthus. Other common presenting symptoms can be redness or pain along the distended lacrimal sac. While it can appear as a pretty minor condition at presentation to the clinicians, it can have devastating complications like abscess formation, orbital cellulitis, loss of vision, or cavernous sinus thrombosis if not treated appropriately.

Understanding the anatomy and flow of tears can help better understand dacryocystitis and potential treatment options. Aqueous tear production begins in the lacrimal gland. The tears are spread over the ocular surface with blinking of the eyelids, thus lubricating the eye. The tears are collected by the superior and inferior puncta and drained into the respective canaliculi. The tears further flow into the common canaliculus, then through the valve of Rosenmuller into the lacrimal sac. The collected tears travel down the NLD, passing through the distal valve of Hasner, and ultimately drain into the inferior meatus of the nasal cavity. The fibres of the orbicularis oculi muscle surround the canaliculi and the lacrimal sac. The contraction and relaxation of the pretarsal orbicularis muscle contribute to the mechanical pumping action, aiding in tear drainage. Failure of the pretarsal fibres of the orbicularis muscle can cause failure of the physiological pumping action for tear drainage. This leads to persistent tearing in the absence of an anatomical blockage or dacryocystitis.

The earliest mention of the disease is found in the works of Hippocrates and von Galen, who described a conventional management strategy for dacryocystitis. The first definitive surgical treatment was suggested by Toti in the form of a dacryocystorhinostomy (DCR) in 1904. This approach has since undergone numerous modifications and refinements to the current advanced management modalities.