Acute dacryocystitis frequently is extremely painful and slow to resolve even with systemic antibiotic therapy. We have identified that incision, drainage, and direct application of antibiotics inside the infected sac result in almost immediate resolution of pain and rapid control of infection. This also provides optimal culture material. Twelve consecutive patients treated in this manner had rapid control of the acute infectious process. All eight patients subsequently undergoing dacryocystorhinostomy were fully cured. A total of 58.3% of the patients were infected with gram-negative rods; 50% of the isolates were resistant to most oral antibiotics.