Lid/Orbit
Dacryocystitis
Also known as: lacrimal sac infection, medial canthal swelling, lacrimal sac abscess, NLD obstruction infection, tearing with discharge, epiphora infection, lacrimal sac inflammation, watery eye with discharge
Filed as: Urgent
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Infection of the lacrimal sac, almost always secondary to nasolacrimal duct obstruction. Presents as acute or chronic disease. Acute: tender, red, fluctuant swelling at the medial canthus below the medial palpebral ligament. Chronic: epiphora with mucopurulent reflux on sac compression. Requires systemic antibiotics and ultimately dacryocystorhinostomy (DCR) to restore drainage.
Recognition
Symptoms: what patients report
- Acute: painful, swollen, red mass at the medial canthus — the patient may describe it as a 'lump below the inner corner of the eye'.
- Fever and malaise in acute disease.
- Chronic: persistent watering (epiphora) and mucopurulent discharge, especially on waking.
- Mucus or pus reflux from the punctum when the medial canthal area is compressed.
- History of chronic epiphora or prior lacrimal sac problems.
Signs: what the examination shows
- Tender, erythematous, fluctuant swelling below the medial palpebral ligament — the key anatomical location distinguishing dacryocystitis from canaliculitis.
- Mucopurulent reflux from the puncta on compression of the lacrimal sac.
- Conjunctival injection, usually confined to the medial bulbar conjunctiva.
- Fistula formation on the skin surface may occur in chronic or inadequately treated cases.
- Fever and elevated white cell count in acute disease.
What OptoGuide™ covers for dacryocystitis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Dacryocystitis (acute) — College of Optometrists CMG
- Dacryocystitis — EyeWiki
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Orbital Cellulitis Secondary to Dacryocystitis: A Case Series and Literature Review. O'Rourke M, Tang YF, Pick Z, et al. Ophthalmic Plastic and Reconstructive Surgery. 2025 May-Jun 01;41(3):306-314.
- Ethmoiditis Mimicking Acute Dacryocystitis-an Underreported Pathology. Arès S, Lavigne P, Kalin-Hajdu E. Ophthalmic Plastic and Reconstructive Surgery. 2026 Jul-Aug 01;42(4):391-396.
- Extension of Masses Involving the Lacrimal Sac to Above the Medial Canthal Tendon. Vahdani K, Gupta T, Verity DH, Rose GE. Ophthalmic Plastic and Reconstructive Surgery. 2021 Nov-Dec 01;37(6):556-559.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.