Purpose

The study aims to delineate the spectrum of etiologies associated with acute dacryocystitis in the absence of fixed nasolacrimal duct obstruction, including dacryolithiasis, viral infections such as Epstein–Barr virus, idiopathic transient obstruction, and congenital or acquired anatomical variations and to distinguish this entity from related clinical mimickers such as acute dacryocystic retention and pseudo-dacryocystitis.

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Methods

A focused literature review of PubMed and MEDLINE was conducted to identify English-language reports of acute dacryocystitis occurring in patients with a patent nasolacrimal drainage system. Relevant articles were analyzed for etiology, clinical features, diagnostic methods, management, and outcomes, and contextualized with representative clinical experience from a tertiary oculoplastic service.

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Results

Acute dacryocystitis in the setting of a patent nasolacrimal drainage system is reported more frequently in pediatric and young adult populations and is thought to result from transient functional obstruction, commonly at the level of the inferior meatus due to mucosal edema, viral-associated lymphoid congestion, or dacryolith impaction. Although the acute presentation often mimics dacryocystitis associated with fixed nasolacrimal duct obstruction, post-inflammatory nasolacrimal irrigation in many cases confirms anatomical patency. Most patients respond to systemic antibiotic therapy, with surgical intervention reserved for recurrent disease or identifiable structural abnormalities.

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Conclusion

Acute dacryocystitis can occur despite nasolacrimal duct patency, often due to transient or functional obstruction. Recognition of this entity and confirmation of post-inflammatory patency are essential to avoid unnecessary dacryocystorhinostomy, with definitive management guided by recurrence and underlying anatomical findings.

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Additional Authors

First name	Last name	Base Hospital / Institution
Adel	AlSuhaibani	King Saud University

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