Lacrimal Abscess

Ever had a tear duct block? Did it cause an infection, resulting in a big, red, painful swelling with pus discharge? Just like what you see here in picture —-

What do you do now?

Well, surgery to create an alternative passage for the tear duct is the ultimate treatment. But this is a painful swelling and it stings. So in the interim – what can be done?

1. Drain the swelling/abscess – How?
   • Traditionally, they would give a small anesthetic injection over the abscess and then give a small cut and drain the entire pus from within.
   • Pros: pus is drained which reduces the pain and the infection load.
   • Cons: needs to done in a procedure room or the operating theatre, is a bigger procedure and has a small risk of creating an opening which drains pus continuously or as we call it ‘fistula’.
   • Would I do it differently? – yes – I would only aspirate the contents of the swelling directly using a needle and syringe.
   • Pros: pus is drained which reduces the pain and the infection load, no need for a local anesthetic injection, no need to go to a procedure room or the operating theatre, no chances of fistula formation, less painful
   • Cons: cannot drain the entire swelling – but that is not the aim anyways – the drianage is just to buy time till the surgery and get material for microbiology test if needed.

2. Warm compresses: Take warm water, dip a clean cotton cloth, squeeze it completely and apply over the swelling. Do it 2-3 times/day for 10 mins each. This will help reduce pain and the swelling.

3. Oral antibiotics: Start broad spectrum oral antibiotics as prescribed by your doctor. remember to complete the entire course.

4. Surgery: Dacryocystorhinostomy – external or endoscopic – is the ultimate treatment to prevent recurrences of such a painful lesion. Endoscopic approach can be done immediately even with the swelling still present whereas for external approach you need to wait till the acute infection and the swelling subsides. But in the end both have equal success rates when done correctly.

I hope this helps. I will put the reference down for the paper that we published explaining the rationale behind this approach – please feel free to read it.

Bothra N, Saini P, Ali MJ. Endoscopic and radiological evidence refuting intra-abscess septae. Orbit. 2023;42:355-359.