Dacryocystitis is an infection of the lacrimal sac, the small pouch that collects tears at the inner corner of your eye before they drain into your nose. It happens when the tear drainage pathway becomes blocked, trapping tears and creating a breeding ground for bacteria. The condition is most common in women and typically strikes between the ages of 30 and 60, though it can also affect newborns.
How the Infection Develops
Your eyes constantly produce tears that wash across the surface and drain through two tiny openings (puncta) near the inner corner of each eyelid. From there, tears flow into the lacrimal sac and then down through a narrow channel called the nasolacrimal duct into your nose. That’s why your nose runs when you cry.
Dacryocystitis begins when something blocks this drainage pathway, most often at the junction where the lacrimal sac meets the nasolacrimal duct. The blockage can be partial or complete. Once tears can’t drain normally, they pool in the lacrimal sac. That stagnant fluid becomes an ideal environment for bacteria to multiply and for protein-rich debris to accumulate. As the infection takes hold, the tissues around the inner corner of the eye become inflamed and swollen.
Acute vs. Chronic Dacryocystitis
The condition comes in two forms, and the main distinction is timing. Acute dacryocystitis comes on suddenly, often over a day or two, and generally resolves within three months with treatment. Chronic dacryocystitis develops gradually and persists for longer periods.
Acute dacryocystitis tends to produce more dramatic symptoms: significant pain and swelling near the inner corner of the eye, redness or skin discoloration, warmth over the swollen area, and sometimes fever. You may notice pus draining from the corner of the eye, especially if you press gently on the swollen area. The swelling can be severe enough that it partially closes the eye.
Chronic dacryocystitis is more subtle. The main symptom is persistent watery eyes, sometimes with mild tenderness near the inner corner. Fever is uncommon. The chronic form is more frequently associated with autoimmune or systemic conditions that cause ongoing inflammation in the drainage pathway.
Who Gets It and Why
Women account for roughly 74% of dacryocystitis cases, according to a large prospective study from a tertiary eye care center. The average age at diagnosis is around 44, with the highest number of cases occurring in people between 41 and 50. About half of all cases fall in the third through sixth decades of life.
The blockage that triggers dacryocystitis can result from several things. Chronic sinus infections, nasal polyps, or deviated septums can narrow the drainage pathway. Previous facial trauma or surgery near the nose and eyes can cause scarring that blocks the duct. Age-related narrowing is another common cause, as the duct gradually becomes smaller over time. In some cases, no clear cause is found.
The Bacteria Involved
The types of bacteria behind dacryocystitis differ depending on whether the infection is acute or chronic. In acute cases, MRSA (a drug-resistant staph bacteria) and Pseudomonas are the most frequently identified organisms, each accounting for about 28% of cultures. These are aggressive bacteria, which explains why acute episodes escalate quickly.
Chronic dacryocystitis tends to harbor less aggressive organisms. Coagulase-negative staphylococci, a group of bacteria commonly found on skin, are the most common isolates at about 19% of chronic cases. Anaerobic bacteria (those that thrive without oxygen) also play a role, particularly in the stagnant, low-oxygen environment of a chronically blocked lacrimal sac.
How It’s Diagnosed
Most of the time, a doctor can diagnose dacryocystitis based on appearance alone. The combination of a painful, red, swollen bump at the inner corner of the lower eyelid, along with excessive tearing or discharge, is characteristic enough to make the diagnosis clinically. Pressing gently over the lacrimal sac often produces a reflux of mucus or pus through the tear ducts, which confirms the obstruction.
If the diagnosis is uncertain or the infection keeps coming back, your doctor may order imaging (typically a CT scan) to look for structural problems, tumors, or sinus disease that could be causing the blockage. A dye test, where a fluorescent drop is placed in the eye to see if it drains into the nose, can confirm whether the drainage pathway is open or obstructed.
Treatment for Acute Infections
Acute dacryocystitis requires antibiotics to clear the infection. Your doctor will typically prescribe oral antibiotics, and you may also receive antibiotic eye drops. Warm compresses applied several times a day help relieve pain and encourage drainage. If an abscess forms (a walled-off pocket of pus), it may need to be drained in the office or hospital.
Once the acute infection resolves, the underlying blockage still needs to be addressed. Without treatment for the obstruction itself, the infection is likely to return.
Surgery for Recurring or Chronic Cases
The definitive treatment for dacryocystitis caused by nasolacrimal duct obstruction is a surgical procedure called dacryocystorhinostomy, or DCR. The surgery creates a new pathway for tears to drain directly from the lacrimal sac into the nasal cavity, bypassing the blocked duct entirely.
DCR can be performed through a small skin incision near the nose (external approach) or entirely through the nostril using a camera (endoscopic approach). Both approaches have high success rates. External DCR consistently achieves success rates above 90% in most published series. Endoscopic DCR avoids a visible scar and has reported success rates in the range of 84% to 91%, depending on the surgical technique used. The choice between approaches often comes down to surgeon experience and the specifics of each case.
Recovery from DCR typically involves a week or two of mild swelling and nasal congestion. A small silicone tube is sometimes left in the new drainage channel for several weeks to keep it open while healing occurs. Most people notice relief from tearing and infections within a few weeks of surgery.
Dacryocystitis in Newborns
Babies can develop dacryocystitis when they’re born with a membrane blocking the lower end of the nasolacrimal duct, a condition called congenital nasolacrimal duct obstruction. This is actually quite common. Most of the time, the membrane opens on its own during the first year of life.
The first-line treatment is a technique called Crigler massage, or lacrimal sac massage. A parent places their index finger over the inner corner of the baby’s eye to block the upper openings, then strokes firmly downward along the side of the nose. This builds hydrostatic pressure inside the lacrimal sac and can rupture the thin membrane blocking the duct. The recommended routine is five to ten strokes, four times a day. Massaging both sides, even if only one eye is affected, makes the process easier.
If symptoms persist beyond 12 months of age, the standard next step is probing of the nasolacrimal system under general anesthesia. A thin, smooth probe is passed through the tear drainage pathway to physically open the blockage. This is a brief outpatient procedure with a high success rate in young children.
Complications of Untreated Infection
Dacryocystitis that goes untreated can become dangerous. Because the lacrimal sac sits just in front of the thin wall separating the eye socket from the surrounding tissues, infection can spread into the orbit. Orbital cellulitis, a serious infection of the tissues around the eye, is the most concerning complication. In a case series of patients who developed orbital abscesses from acute dacryocystitis, those whose abscesses formed deeper in the eye socket experienced vision loss, while patients with more superficial abscesses were able to retain their vision.
In rare cases, untreated infection can spread further, leading to blood infection or even reaching the veins behind the eyes. Acute dacryocystitis is considered an ophthalmic emergency precisely because of these risks. Prompt treatment with antibiotics, and drainage when needed, prevents the vast majority of serious complications.