Acute dacryocystitis: From emergency management to definitive treatment

Background: Acute dacryocystitis is a common condition in dacryology; its sudden onset, painful nature, and the potential for locoregional spread of infection contribute to its severity.

Case Presentation: This is a retrospective study covering a 4-year period from August 2022 to March 2026, including all adult patients who presented to the ophthalmology emergency department at our hospital for acute dacryocystitis.

A total of 83 cases were included, with a mean age of 45 years (range: 17 to 76 years) and a predominance of female patients (68%); 75% of patients reported chronic tearing, and 25% reported a previous episode of acute dacryocystitis. Clinically, 35% of patients presented with a lacrimal sac fistula, and 15% had associated pre-septal cellulitis.

All patients initially received antibiotic therapy (dual- or triple-antibiotic regimen) and anti-inflammatory treatment, and 55% underwent lacrimal sac puncture with bacteriological analysis.

All patients subsequently underwent evaluation of the lacrimal ducts and were scheduled for external dacryocystorhinostomy, with a favorable long-term clinical outcome in 85% of cases. Acute dacryocystitis, like most lacrimal disorders, is more common in women, and its diagnosis is generally straightforward.

The prognosis is usually favorable with treatment; however, orbital cellulitis may occur in immunocompromised or elderly patients and may itself be complicated by the serious condition of cavernous sinus thrombophlebitis

Conclusion: Acute dacryocystitis is a diagnostic and therapeutic emergency most often associated with idiopathic stenosis of the nasolacrimal duct. The risk lies in the possibility of serious infectious complications. Emergency management is medical, followed by surgical intervention secondary after the acute episode.