Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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A tender tear sac may need hospital care
Acute dacryocystitis can spread into surrounding tissues, particularly in infants; orbital signs or systemic illness indicate a potentially serious infection.
Action: Arrange same-day emergency hospital assessment for affected children or severe adult disease, and immediate escalation for visual change, proptosis, painful eye movements or sepsis.
Synopsis
Separate chronic tear-drainage failure from acute lacrimal-sac infection, recognise infant and orbital emergencies and plan antimicrobial care or definitive drainage treatment.
Drainage obstruction commonly causes epiphora and intermittent mucoid discharge.
Acute dacryocystitis causes a tender inflamed lacrimal-sac swelling, usually below the medial canthal tendon.
A sticky eye in an otherwise well infant is not automatically conjunctivitis.
Key red flags
A painful red swelling near the medial canthus in a neonate or infant.
Well infant with simple wateringSupport drainage and observe development
Congenital obstruction is likely and there are no corneal or infection warning signs.
Demonstrate safe cleaning and the locally recommended downward lacrimal-sac massage technique.
Explain that antibiotics do not open the duct and are reserved for selected infection or significant discharge after clinical assessment.
Key medicines
Co-amoxiclav for selected mild adult dacryocystitisThe cited NHS Ayrshire and Arran regimen uses 500 mg/125 mg orally every eight hours for seven days when renal function permits.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.