Chronic dacryocystitis is most commonly seen in middle-aged and elderly women and is the most frequent disease of the lacrimal sac. It typically arises secondary to nasolacrimal duct narrowing or obstruction, which leads to tear retention within the lacrimal sac and secondary bacterial infection. The condition is often unilateral, with common causative pathogens including Streptococcus pneumoniae and Candida albicans. The causative microorganisms can be identified through staining and microscopic examination of secretions refluxed from the puncta. The development of chronic dacryocystitis is associated with other conditions such as trachoma, lacrimal duct trauma, rhinitis, nasal septum deviation, and inferior turbinate hypertrophy.
Clinical Manifestations
The primary symptom is excessive tearing (epiphora). Upon applying pressure to the lacrimal sac, mucus or purulent discharge often flows out from the puncta. During lacrimal irrigation, the flushing fluid refluxes from the puncta, typically accompanied by mucus or purulent discharge.
Chronic dacryocystitis serves as an infectious focus for the eye. The accumulation of mucus within the sac provides an environment for the proliferation of highly virulent bacteria. Reflux of purulent material into the conjunctival sac results in chronic bacterial colonization of the conjunctival sac. If ocular trauma occurs or intraocular surgery is performed, this can lead to secondary purulent infections, including bacterial corneal ulcers or purulent endophthalmitis. Therefore, chronic dacryocystitis poses a significant potential threat to the eye, particularly in the context of intraocular surgery. Routine evaluation of the lacrimal system is essential prior to intraocular procedures, and chronic dacryocystitis must be appropriately managed before surgery.
Treatment
Surgical intervention is the preferred treatment method, with the therapeutic principle being the restoration of lacrimal drainage patency. Common surgical approaches include external dacryocystorhinostomy (DCR) or endoscopic DCR. Advances in endoscopy, laser technology, and intubation techniques have made the treatment of lacrimal duct narrowing and obstruction safer, less invasive, and more effective.