The lacrimal excretory system is prone to infection and inflammation for various reasons. This mucous membrane-lined tract is contiguous with 2 surfaces (conjunctival and nasal mucosal) that are normally colonized with bacteria. The functional purpose of the lacrimal excretory system is to drain tears from the eye into the nasal cavity. Stagnation of tears in a pathologically closed lacrimal drainage system can result in dacryocystitis.

Acquired dacryocystitis can be acute or chronic.[1] Acute dacryocystitis is heralded by the sudden onset of pain and redness in the medial canthal region. An insidious onset of epiphora is characteristic of chronic inflammation or infection of the lacrimal sac.

See the image below.

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Acute dacryocystitis.

A special form of inflammation of the lacrimal sac is that of congenital dacryocystitis, the pathophysiology of which is intimately related to the lacrimal excretory system embryogenesis.

Dacryocystitis has long been noted to occur more frequently on the left side than on the right side. In many instances, the nasolacrimal duct and lacrimal fossa formed a greater angle on the right side than on the left side.


The naso-optic fissure is the source of origin of the lacrimal drainage system. The ectoderm in this region thickens and becomes embedded in the mesenchyme between the lateral nasal and maxillary processes. This cord of ectoderm subsequently canalizes and opens into the conjunctival fornix prior to opening into the nasal vestibule. Frequently, this opening into the nasal cavity is incomplete at birth. Canalization of the lacrimal excretory system begins in the superior portion first and is segmental, only later coalescing to form a continuous lumen. The canaliculi, which develop as outpouchings from the solid cord of ectodermal tissue prior to canalization, also canalize prior to the vertical portions of the nasolacrimal duct.

Many variations in the anatomy of the lacrimal drainage system have been noted. Normally, tears drain into the lacrimal system through two puncta, one present in the upper lid and the other in the lower lid. More commonly, the lower punctum lies slightly temporal to the upper punctum.

The connections from the puncta to the lacrimal sac are called canaliculi. These canaliculi have a short vertical segment, averaging 2 mm in length, and a longer horizontal segment, averaging 10-12 mm in length.

An ampulla connects the vertical and horizontal segments. The individual canalicular horizontal segments join to form a common canaliculus in 90% of patients. This common canaliculus dilates, forming the sinus of Maier just lateral to the lacrimal sac.

A fold of mucosa known as the valve of Rosenmüller marks the junction of the lacrimal sac and the common canaliculus. The lacrimal sac lies in the bony lacrimal fossa derived from the lacrimal and maxillary bones. The average width of the sac is approximately 6-7 mm and the length varies from 12-15 mm. The mucosa of the sac is lined by pseudostratified columnar epithelium with substantial amounts of lymphoid and elastic tissue interposed within the connective tissue layer. The sac is normally irregular and flat in shape with a collapsed lumen.

The lacrimal sac is covered on its outer surface by the lacrimal fascia of the periorbita. This fascia splits to envelop the lacrimal sac between the attachments of the lacrimal fascia to the anterior and posterior lacrimal crests. The lacrimal sac mucosa only loosely adheres to the lacrimal fascia. However, posterior to the sac are the deep heads of the pretarsal and preseptal orbicularis muscles. Anteriorly, the medial canthal tendon covers the upper two fifths of the lacrimal sac.

The nasolacrimal duct averages 18 mm in length and 4.5-5 mm in diameter. Multiple valves are present in the nasolacrimal duct, representing analog from the segmental canalization of the ectodermal cord that develops into the nasolacrimal duct. Of these, the most prominent valves are the valve of Taillefer, the valve of Krause, and the valve of Hasner (located at the junction of the duct with the nasal mucosa). Like the lacrimal sac, the nasolacrimal duct is lined by pseudostratified columnar epithelium.

The lacrimal, maxillary, and ethmoid bones form the bony nasolacrimal canal. The bulk of the duct is contributed by the maxilla, anteriorly, laterally, and posteriorly. The lacrimal bone forms the medial wall superiorly, and the inferior concha of the ethmoid bone forms the medial wall of the canal inferiorly. The mucosal opening of the nasolacrimal duct under the inferior turbinate lies 5-8 mm from the anterior tip of the inferior turbinate. The lacrimal bone and the nasal process of the maxilla make up the lacrimal fossa equally. The anterior and posterior lacrimal crests form the anterior and posterior borders of the lacrimal fossa, respectively.

The dimensions of the lacrimal fossa are 4-8 mm in width, 15 mm in height, and 2 mm in depth. Ethmoid air cells in approximately 40-60% of patients separate the lacrimal fossa from the nasal cavity, although considerable variability exists in the number and location of these air cells. The lacrimal sac fossa lies at the level of the anterior tip of the middle turbinate.



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Individuals with brachycephalic heads have a higher incidence of dacryocystitis than dolichocephalic or mesocephalic skulls. This is because brachycephalic skulls demonstrate a narrower diameter of inlet into the nasolacrimal duct, the nasolacrimal duct is longer, and the lacrimal fossa is narrower. Furthermore, patients with a flat nose and narrow face are at a higher risk for developing dacryocystitis, presumably because of the narrow osseous nasolacrimal canal.

In 1883, Nieden noted a 9% incidence of hereditary lacrimal excretory system inflammation. This is significantly higher than what has been found by the author in studies.


Dacryocystitis occurs in the following 3 forms: acute, chronic, and congenital.

In acute dacryocystitis, patients can experience severe morbidity and rarely mortality. Morbidity is related primarily to the lacrimal sac abscess and spread of the infection.

Chronic dacryocystitis is rarely associated with severe morbidity unless caused by a systemic disease. The primary morbidity is associated with chronic tearing, mattering, and conjunctival inflammation and infection.

Congenital dacryocystitis is a very serious disease associated with significant morbidity and mortality. If not treated promptly and aggressively, newborn infants can experience orbital cellulitis (because the orbital septum is formed poorly in infants), brain abscess, meningitis, sepsis, and death. Congenital dacryocystitis can be associated with an amniotocele, which, in severe cases, can lead to airway obstruction. More indolent forms of congenital dacryocystitis can be difficult to diagnose and can be associated with chronic tearing, mattering, amblyopia, and failure to thrive.


Blacks rarely develop dacryocystitis because the nasolacrimal ostium into the nose is large. In addition, the lacrimal canal is shorter and straighter in blacks than in whites.


In adults, females are afflicted more commonly by dacryocystitis. Most studies demonstrate that 70-83% of cases of dacryocystitis occur in females. Congenital dacryocystitis occurs with equal frequency in both sexes.


Lacrimal sac infections and inflammations commonly occur in 2 discrete age categories, infants and adults older than 40 years. Acute dacryocystitis in newborns is rare, occurring in fewer than 1% of all newborns. Acquired dacryocystitis is primarily a disease of females and is most common in patients older than 40 years, with a peak in patients aged 60-70 years.


See the list below:


Fever results from a fulminant bacterial or fungal infection in the lacrimal sac, which spreads to the surrounding tissues. This is not uncommonly associated with significant sinus disease.

Leukocytosis also is common in acute dacryocystitis.

Cellulitis surrounding the affected lacrimal sac is common in patients with acute dacryocystitis. This can spread to involve the orbit and cause orbital cellulitis.

Altered visual acuity most frequently is caused by an abnormal tear film with abnormal refraction of light at the air-tear film interface. It also can be due to corneal surface irregularities resulting from chronic surface inflammation.

Altered pupillary reaction is only seen in severe cases of dacryocystitis associated with an orbital cellulitis. This is due to increased intraorbital pressure and necrosis of the pupillomotor fibers in the orbit.

Diplopia is also rare and is seen in patients with orbital cellulitis resulting from acute dacryocystitis. These patients have orbital inflammation involving the extraocular muscles, which causes the muscles to dysfunction, resulting in diplopia.

Loss of peripheral vision is also rare and caused by orbital cellulitis secondary to acute dacryocystitis. This results in an optic neuropathy with loss of peripheral vision. Many times, this can be subtle and can be detected on perimetry testing.

Conjunctivitis frequently is associated with acute and chronic dacryocystitis. It is primarily due to the buildup of toxic debris on the surface of the eye, including the exotoxin produced by staphylococcal organisms, which normally inhabit the surface of the eye.

Medial canthal fullness and tenderness are common in both acute dacryocystitis and chronic dacryocystitis, which is due to distention of the lacrimal sac and resultant infection of the lacrimal sac. Rarely, an occult tumor or cyst can be the cause of the medial canthal fullness.

Tearing is most commonly due to obstructed outflow of the tear system but may be exacerbated by conjunctivitis. Rarely, patients with acute or chronic dacryocystitis have no complaints of tearing but have other sequelae of tear sac infection, including redness, cellulitis, pain, fullness, and purulent discharge.


See the list below:

Laboratory Studies

In most patients, physicians make a clinical diagnosis of dacryocystitis.

Supportive laboratory analysis includes a complete blood count to assess the degree of leukocytosis; however, this rarely may assist in the determination of leukemia as an etiology of the lacrimal sac infection.

Blood cultures and cultures of the ocular surface, nose, and lacrimal sac discharge may prove useful in determining the appropriate antibiotic therapy.

Antineutrophil cytoplasmic antibody testing may be useful in ruling out Wegener granulomatosis as a cause of dacryocystitis and nasolacrimal duct obstruction.

Antinuclear antibody (ANA) testing may be useful in the very rare cases of dacryocystitis caused by lupus involvement of the lacrimal drainage system with resultant obstruction and infection.

Imaging Studies

Plain films may be useful in elucidating facial skeletal anomalies or foreign bodies as the cause of the lacrimal disorder. In addition, occasionally, posttraumatic etiologies and mass lesions are noted on plain films as the cause of dacryocystitis.

Echography rarely is used. In most cases, it demonstrates enlargement and engorgement of the lacrimal sac. Rarely, lacrimal sac foreign bodies or masses are noted on echography.

CT scans are useful in patients suspected of harboring an occult malignancy or mass as a cause of dacryocystitis. In addition, posttraumatic causes of dacryocystitis usually are noted with CT scans.

MRIs are not as useful as CT scans but can be helpful in differentiating cystic lesions from solid mass lesions. MRIs can be useful in identifying patients with lacrimal sac diverticuli, which can cause recurrent dacryocystitis without epiphora and failure of surgical correction.

Dacryocystography (DCG) and dacryoscintigraphy are useful adjunctive diagnostic modalities when anatomical abnormalities of the nasolacrimal drainage system are suspected. Subtraction DCG with CT scan is also very sensitive to study the anatomy of the lacrimal sac and surrounding structures.

Other Tests

Schirmer basic secretor testing

Ensure that epiphora is not related to hypersecretion or abnormal lid function or position.

Baseline tear secretion can be measured with the Schirmer basic secretor test.

Dye disappearance testing

A somewhat subjective test, it is used to assess the disappearance of fluorescein dye when placed in the eye. The ocular surface is evaluated at the slit lamp to determine disappearance of the fluorescein dye. This test is useful in children.


See the list below:

Histologic Findings

Pathologic changes found in the lacrimal drainage system are related primarily to the etiology of the disease.

Because the most common underlying pathogenic factor is distal obstruction of the lacrimal drainage system with subsequent stagnation and infection, the most common pathologic finding in the lacrimal drainage system is inflammatory change. Chronic inflammation and fibrosis of the lacrimal sac are present in varying degrees in most patients.

Focal ulceration and loss of goblet cells are not uncommon.

Focal abscesses and granuloma formation also have been noted in the lacrimal sac.

The pathologic changes in the nasolacrimal duct and nasal mucosa follow closely to those in the lacrimal sac.

Chronic inflammation and fibrosis are the most common histologic changes noted in both the nasal mucosa and the nasolacrimal duct.

Medical Care

The treatment of dacryocystitis depends upon the clinical manifestations of the disease.

Surgical Care

See the list below:


See the list below:

Medication Summary

Oral and topical antibiotics are the mainstay of medical therapy.[13]

Amoxicillin and clavulanate (Augmentin)

Clinical Context:  Provides useful coverage for most organisms associated with dacryocystitis.

Ampicillin and sulbactam (Unasyn)

Clinical Context:  Provides useful coverage for most organisms associated with dacryocystitis.

Levofloxacin (Levaquin)

Clinical Context:  Provides useful coverage for most organisms associated with dacryocystitis.

Trimethoprim sulfate and polymyxin B sulfate (Polytrim)

Clinical Context:  For ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic. Available as a solution and ointment.

Gentamicin (Genoptic, Ocumycin)

Clinical Context:  Aminoglycoside antibiotic used for gram-negative bacterial coverage.

Tobramycin ophthalmic (AKTob, Tobrex)

Clinical Context:  Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, which results in a defective bacterial cell membrane.

Dexamethasone/tobramycin (TobraDex)

Clinical Context:  Tobramycin interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, which results in a defective bacterial cell membrane. Dexamethasone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Class Summary

Used to treat systemic infections, including periorbital cellulitis, orbital cellulitis, and sinusitis.

Further Outpatient Care

Most patients are treated surgically on an outpatient basis.

Further Inpatient Care

Admission to the hospital is required for the following:

Definitive surgical therapy should be performed; in most cases, this involves dacryocystorhinostomy.

Inpatient & Outpatient Medications

Topical antibiotics include Polytrim, gentamicin, tobramycin, and TobraDex (antibiotic/steroid combination drop).

Occasionally, nasal decongestants (eg, Afrin) are used on a short-term basis.

Oral antibiotics are useful in patients with acute dacryocystitis who are not acutely ill.

Intranasal saline may be useful postoperatively to keep the surgical ostium clean and open.


Patients may require transfer for diagnostic evaluation of associated systemic illnesses, such as Wegener granulomatosis, sarcoidosis, leukemia, lymphoma, and melanoma.


Proper eyelid hygiene, including warm compresses and eyelid scrubs, may prevent some cases of dacryocystitis.

Nasal hygiene with saline spray may help prevent distal lacrimal outflow obstruction.


Dacryocystorhinostomy, when properly performed, is a very safe and effective procedure. However, as with all surgical procedures, severe complications can occur.

Hemorrhage is the most notable complication and has been reported to occur in approximately 3% of patients. Considerations are as follows:

Infection is also a serious concern with dacryocystorhinostomy. Almost routinely, patients with diabetes and children who undergo dacryocystorhinostomy are on postoperative oral antibiotics. Some surgeons advocate spraying antibiotic drops into the nose postoperatively. More commonly, a suture abscess is noted, which can be treated with removal of the offending suture, hot compresses, and oral and topical antibiotics.

Cerebrospinal fluid (CSF) leakage is the most dreaded complication of dacryocystorhinostomy. Because the cribriform plate lies just above the medial canthal tendon, tears in the bony plate with resultant CSF leakage can occur during creation of the osteotomy. Variations in anatomy are frequently responsible for the above complication. The author has observed a CSF leakage from dacryocystorhinostomy in a patient who had an arachnoid cyst extending from the anterior cranial fossa into the nasal vestibule just under the surface of the skin.

Failure of the dacryocystorhinostomy is most commonly due to an inadequate osteotomy or a fibrous closure at the surgical ostium. Most cases of the latter can be treated with dilation of the ostium with successively larger Bowman probes. Balloon dacryocystoplasty has been shown to be effective in patients who fail dacryocystorhinostomy surgery.

Rarely, a papilloma, which is occluding the ostium, can be seen intranasally. This can be removed during intranasal revision of the osteotomy.

Fortunately, few patients fail dacryocystorhinostomy; those patients who do most often necessitate placement of a Jones tube.


The success rate of external dacryocystorhinostomy is approximately 95%.[14]

Premature stent loss (prior to 2 months in one study[15] ) resulted in a success rate of 90%.

Intranasal dacryocystorhinostomy has a slightly lower success rate, presumably due to the inability to create as large an ostium.

Laser-assisted dacryocystorhinostomy is promising in that less morbidity is seen with the procedure; however, the success rate appears to be approximately 80-85%.

Balloon dacryoplasty is also a useful procedure in select patients and in patients who fail primary dacryocystorhinostomy. The author offers balloon dacryoplasty to patients with focal partial stenosis.

The conjunctival flora has been shown to normalize a few weeks after dacryocystorhinostomy.[16]


Grant D Gilliland, MD, Private Practice, Texas Ophthalmic Plastic, Reconstructive and Orbital Surgery Associates

Disclosure: Nothing to disclose.

Specialty Editors

Simon K Law, MD, PharmD, Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Disclosure: Nothing to disclose.


  1. Mills DM, Bodman MG, Meyer DR, Morton AD 3rd. The microbiologic spectrum of dacryocystitis: a national study of acute versus chronic infection. Ophthal Plast Reconstr Surg. 2007 Jul-Aug. 23(4):302-6. [View Abstract]
  2. Pinar-Sueiro S, Sota M, Lerchundi TX, Gibelalde A, Berasategui B, Vilar B, et al. Dacryocystitis: Systematic Approach to Diagnosis and Therapy. Curr Infect Dis Rep. 2012 Jan 29. [View Abstract]
  3. Burduk PK, Dalke K, Olejarz E. [Dacryocystitis as a complication of maxillofacial fracture repair with reconstruction]. Otolaryngol Pol. 2008. 62(5):536-9. [View Abstract]
  4. Batra R, Mudhar HS, Sandramouli S. A unique case of IgG4 sclerosing dacryocystitis. Ophthal Plast Reconstr Surg. 2012 May-Jun. 28(3):e70-2. [View Abstract]
  5. Mazow ML, McCall T, Prager TC. Lodged intracanalicular plugs as a cause of lacrimal obstruction. Ophthal Plast Reconstr Surg. 2007 Mar-Apr. 23(2):138-42. [View Abstract]
  6. Ghose S, Chhabra MS, Thakar A, et al. Nasal endoscopy in congenital dacryocystitis. J Pediatr Ophthalmol Strabismus. 2006 Nov-Dec. 43(6):341-5. [View Abstract]
  7. Baskin DE, Reddy AK, Chu YI, Coats DK. The timing of antibiotic administration in the management of infant dacryocystitis. J AAPOS. 2008 Oct. 12(5):456-9. [View Abstract]
  8. Spielmann PM, Hathorn I, Ahsan F, Cain AJ, White PS. The impact of endonasal dacryocystorhinostomy (DCR), on patient health status as assessed by the Glasgow benefit inventory. Rhinology. 2009 Mar. 47(1):48-50. [View Abstract]
  9. Konuk O, Ilgit E, Erdinc A, Onal B, Unal M. Long-term results of balloon dacryocystoplasty: success rates according to the site and severity of the obstruction. Eye. 2008 Dec. 22(12):1483-7. [View Abstract]
  10. Merkonidis C, Brewis C, Yung M, Nussbaumer M. Is routine biopsy of the lacrimal sac wall indicated at dacryocystorhinostomy? A prospective study and literature review. Br J Ophthalmol. 2005 Dec. 89(12):1589-91. [View Abstract]
  11. Wu W, Yan W, MacCallum JK, et al. Primary treatment of acute dacryocystitis by endoscopic dacryocystorhinostomy with silicone intubation guided by a soft probe. Ophthalmology. 2009 Jan. 116(1):116-22. [View Abstract]
  12. Liang WH, Liang YQ, Deng XY, Yuan HZ. Spherical Headed Silicone Intubation in the Treatment of 26 Cases (31 eyes) of Chronic Dacryocystitis under Nasal Endoscopy. Yan Ke Xue Bao. 2011 Dec. 26(4):217-20. [View Abstract]
  13. Miquel T, Abad S, Badelon I, et al. Successful treatment of idiopathic orbital inflammation with infliximab: an alternative to conventional steroid-sparing agents. Ophthal Plast Reconstr Surg. 2008 Sep-Oct. 24(5):415-7. [View Abstract]
  14. Barmettler A, Ehrlich JR, Erlich J, Lelli G Jr. Current preferences and reported success rates in dacryocystorhinostomy amongst ASOPRS members. Orbit. 2013 Feb. 32(1):20-6. [View Abstract]
  15. Vicinanzo MG, McGwin G, Boyle M, Long JA. The consequence of premature silicone stent loss after external dacryocystorhinostomy. Ophthalmology. 2008 Jul. 115(7):1241-4. [View Abstract]
  16. Owji N, Khalili MR. Normalization of conjunctival flora after dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2009 Mar-Apr. 25(2):136-8. [View Abstract]
  17. Artenstein AW, Eiseman AS, Campbell GC. Chronic dacryocystitis caused by Mycobacterium fortuitum. Ophthalmology. 1993 May. 100(5):666-8. [View Abstract]
  18. Asiyo MN, Stefani FH. Pyogenic granulomas of the lacrimal sac. Eye. 1992. 6 (Pt 1):97-101. [View Abstract]
  19. Atkinson PL, Ansons AM, Patterson A. Infectious mononucleosis presenting as bilateral acute dacryocystitis. Br J Ophthalmol. 1990 Dec. 74(12):750. [View Abstract]
  20. Avasthi P, Misra RN, Sood AK. Clinical and anatomical considerations of dacryocystitis. Int Surg. 1971 Mar. 55(3):200-3. [View Abstract]
  21. Bareja U, Ghose S. Clinicobacteriological correlates of congenital dacryocystitis. Indian J Ophthalmol. 1990 Apr-Jun. 38(2):66-9. [View Abstract]
  22. Berkefeld J, Kirchner J, Muller HM, Fries U, Kollath J. Balloon dacryocystoplasty: indications and contraindications. Radiology. 1997 Dec. 205(3):785-90. [View Abstract]
  23. Berlin AJ, Rath R, Rich L. Lacrimal system dacryoliths. Ophthalmic Surg. 1980 Jul. 11(7):435-6. [View Abstract]
  24. Brook I, Frazier EH. Aerobic and anaerobic microbiology of dacryocystitis. Am J Ophthalmol. 1998 Apr. 125(4):552-4. [View Abstract]
  25. Cassady JV. Developmental anatomy of nasolacrimal duct. Arch Ophthalmol. 1952.
  26. Cernea P, Talea L. [Congenital bilateral dacryocystitis and craniofacial dysraphia]. Oftalmologia. 1992 Apr-Jun. 36(2):135-9. [View Abstract]
  27. Coden DJ, Hornblass A, Haas BD. Clinical bacteriology of dacryocystitis in adults. Ophthal Plast Reconstr Surg. 1993 Jun. 9(2):125-31. [View Abstract]
  28. Dryden RM, Wulc AE. Lacrimal inflammations and infections. Oculoplastic, Orbital and Reconstructive Surgery. Vol. 2: 1417-23.
  29. Ducasse A, Hannion X, Adam R, Segal A. [Neonatal dacryocystitis. A case report]. Bull Soc Ophtalmol Fr. 1990 Jun-Jul. 90(6-7):595-7. [View Abstract]
  30. Dutton JJ. Standardized echography in the diagnosis of lacrimal drainage dysfunction. Arch Ophthalmol. 1989 Jul. 107(7):1010-2. [View Abstract]
  31. Eshraghy B, Raygan F, Tabatabaie SZ, Tari AS, Kasaee A, Rajabi MT. Effect of mitomycin C on success rate in dacryocystorhinostomy with silicone tube intubation and improper flaps. Eur J Ophthalmol. 2012 May-Jun. 22(3):326-9. [View Abstract]
  32. Ffooks OO. Dacryocystitis in Infancy. Br J Ophthalmol. 1962 Jul. 46(7):422-34. [View Abstract]
  33. Filipowicz-Banachowa A. [Pathological changes found in the lacrimal sac during nasolacrimal duct surgery]. Klin Oczna. 1991 Feb-Mar. 93(2-3):89-90. [View Abstract]
  34. Flanagan JC, Stokes DP. Lacrimal sac tumors. Ophthalmology. 1978 Dec. 85(12):1282-7. [View Abstract]
  35. Garfin SW. Etiology of dacryocystitis and epiphora. Arch Ophthalmol. 1942. 27:167-88.
  36. Ghose S, Mahajan VM. Fungal flora in congenital dacryocystitis. Indian J Ophthalmol. 1990 Oct-Dec. 38(4):189-90. [View Abstract]
  37. Goldberg SH, Fedok FG, Botek AA. Acute dacryocystitis secondary to exudative rhinitis. Ophthal Plast Reconstr Surg. 1993. 9(1):51-2. [View Abstract]
  38. Harley RD. Diseases of the lacrimal apparatus. Pediatr Clin North Am. 1983 Dec. 30(6):1159-66. [View Abstract]
  39. Hartikainen J, Lehtonen OP, Saari KM. Bacteriology of lacrimal duct obstruction in adults. Br J Ophthalmol. 1997 Jan. 81(1):37-40. [View Abstract]
  40. Hawes MJ. The dacryolithiasis syndrome. Ophthal Plast Reconstr Surg. 1988. 4(2):87-90. [View Abstract]
  41. Heirbaut AM, Colla B, Missotten L. Silicone intubation for congenital obstruction of nasolacrimal ducts. Bull Soc Belge Ophtalmol. 1990. 238:87-93. [View Abstract]
  42. Hurwitz JJ, Rodgers KJ. Management of acquired dacryocystitis. Can J Ophthalmol. 1983 Aug. 18(5):213-6. [View Abstract]
  43. Karesh JW, Perman KI, Rodrigues MM. Dacryocystitis associated with malignant lymphoma of the lacrimal sac. Ophthalmology. 1993 May. 100(5):669-73. [View Abstract]
  44. Lieb WE, Mohr A, Bruhl K. [The value of digital subtraction dacryocystography]. Fortschr Ophthalmol. 1989. 86(6):679-81. [View Abstract]
  45. Liu X. [Culture of anaerobic bacteria and antibiotic sensitivity test in ocular infectious diseases]. Zhonghua Yan Ke Za Zhi. 1991 Mar. 27(2):80-3. [View Abstract]
  46. Mainville N, Jordan DR. Etiology of tearing: a retrospective analysis of referrals to a tertiary care oculoplastics practice. Ophthal Plast Reconstr Surg. 2011 May-Jun. 27(3):155-7. [View Abstract]
  47. Mandal R, Banerjee AR, Biswas MC, Mondal A, Kundu PK, Sasmal NK. Clinicobacteriological study of chronic dacryocystitis in adults. J Indian Med Assoc. 2008 May. 106(5):296-8. [View Abstract]
  48. Marx JL, Hillman DS, Hinshaw KD, Olson JJ, Putterman AM, Lam S. Bilateral dacryocystitis after punctal occlusion with thermal cautery. Ophthalmic Surg. 1992 Aug. 23(8):560-1. [View Abstract]
  49. Mauriello JA Jr, Palydowycz S, DeLuca J. Clinicopathologic study of lacrimal sac and nasal mucosa in 44 patients with complete acquired nasolacrimal duct obstruction. Ophthal Plast Reconstr Surg. 1992. 8(1):13-21. [View Abstract]
  50. McNab AA, Potts MJ, Welham RA. The EEC syndrome and its ocular manifestations. Br J Ophthalmol. 1989 Apr. 73(4):261-4. [View Abstract]
  51. Morgan S, Austin M, Whittet H. The treatment of acute dacryocystitis using laser assisted endonasal dacryocystorhinostomy. Br J Ophthalmol. 2004 Jan. 88(1):139-41. [View Abstract]
  52. Rosen N, Sharir M, Moverman DC, Rosner M. Dacryocystorhinostomy with silicone tubes: evaluation of 253 cases. Ophthalmic Surg. 1989 Feb. 20(2):115-9. [View Abstract]
  53. Schenck NL, Ogura JH, Pratt LL. Cancer of the lacrimal sac. Presentation of five cases and review of the literature. Ann Otol Rhinol Laryngol. 1973 Mar-Apr. 82(2):153-61. [View Abstract]
  54. Singh M, Jain V, Singh SP, Gupta SC. Endoscopic dacryocystorhinostomy in cases of dacryocystitis due to atrophic rhinitis. J Laryngol Otol. 2004 Jun. 118(6):426-8. [View Abstract]
  55. Sodhi PK. Early and late assessment of internal drainage of chronic dacryocystitis. Ophthalmologica. 2004 Jul-Aug. 218(4):288; author reply 289. [View Abstract]
  56. Stefanescu-Dima A, Petria I, Craitoiu S. [Carcinoma of the lacrimal sac]. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Ser Oftalmol. 1989 Jul-Sep. 33(3):231-4. [View Abstract]
  57. Tarbet KJ, Custer PL. External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost. Ophthalmology. 1995 Jul. 102(7):1065-70. [View Abstract]
  58. Udovicki J. [Rhinolithiasis complicated by purulent dacryocystitis]. Med Pregl. 1989. 42(9-10):329-31. [View Abstract]
  59. Valenzuela AA, McNab AA, Selva D, O'Donnell BA, Whitehead KJ, Sullivan TJ. Clinical features and management of tumors affecting the lacrimal drainage apparatus. Ophthal Plast Reconstr Surg. 2006 Mar-Apr. 22(2):96-101. [View Abstract]
  60. van Bijsterveld OP, Klaassen-Broekema N. Lacrimal conjunctivitis. Bull Soc Belge Ophtalmol. 1990. 238:61-9; discussion 69-70. [View Abstract]
  61. Vegh M, Nemeth J. [Ultrasound diagnosis of the lacrimal sack]. Fortschr Ophthalmol. 1990. 87(6):638-40. [View Abstract]
  62. Viers R. Lacrimal disorders. Diagnosis and Treatment. St. Louis: CV Mosby; 1976. 72-88.
  63. Wong SC, Healy V, Olver JM. An unusual case of tuberculous dacryocystitis. Eye. 2004 Sep. 18(9):940-2. [View Abstract]
  64. Zapala J, Bartkowski AM, Bartkowski SB. Lacrimal drainage system obstruction: management and results obtained in 70 patients. J Craniomaxillofac Surg. 1992 May-Jun. 20(4):178-83. [View Abstract]

Acute dacryocystitis.

Acute dacryocystitis.

A 2-week-old infant with life-threatening amniotocele causing airway compromise.

Postoperative image of same patient as in Media file 2, 1 year after drainage of amniotocele.