Process of spontaneous resolution in the conservative management of congenital dacryocystocele

Otoscopy-assisted intranasal cyst marsupialization for congenital dacryocystocele

We describe 3 infants with congenital dacryocystocele resistant to conservative treatment who were treated with a novel, simple intranasal cyst marsupialization (ICM) technique. Otoscopy-guided ICM was performed by an otolaryngologist in the manner of otoscopic myringotomy for cases with nasal cyst distension. All 3 infants were treated successfully by a single surgical procedure under topical anesthesia in an office setting.

Outcomes of lacrimal probing surgery as the first option in the treatment of congenital dacryocystocele

PURPOSE

To determine the demographic and clinical characteristics of newborn patients who underwent lacrimal probing surgical intervention with or without the marsupialization of intranasal cysts as the primary management for dacryocystocele treatment.

METHODS

Data from the medical charts of 350 infants who underwent lacrimal probing surgery due to nasolacrimal duct obstruction were reviewed retrospectively. Ten newborn patients with a naive diagnosis of congenital dacryocystocele were included in the study. Congenital dacryocystocele diagnosis was based on a triad of swelling in the inner canthal region, a bluish appearance, and epiphora. Lacrimal probing surgery accompanied by nasal endoscopy was planned for all patients as the first treatment option.

RESULTS

The mean age of the patients was 24.90 ± 7.15 days, with a range of 6-85 days. A total of 10 patients were included, comprising seven females and three males. The mean postoperative follow-up period was 38.7 ± 24.41 months. Five patients had left, four patients had right, and one patient had bilateral dacryocystocele. Seven eyes of the six patients had uncomplicated dacryocystocele, while the remaining patients had dacryocystocele with complications of dacryocystitis and/or preseptal cellulitis. All patients had intranasal cysts. All patients underwent one session of lacrimal probing surgery under general anesthesia; all with successful outcomes. Four patients with additional dacryocystocele-associated complications underwent combined intranasal marsupialization of the cyst wall.

DISCUSSION

Lacrimal probing surgery ± intranasal marsupialization of the cyst wall as a first treatment option can be effective for both congenital dacryocystocele and/or congenital dacryocystocele plus associated complications and provide complete resolution of dacryocystocele-related symptoms.

Congenital Dacryocystocele: A Major Review

PURPOSE

To provide a systematic review of the literature on congenital dacryocystoceles (CDCs) and summarize their presentations, investigations, management, and outcomes.

METHODS

The authors performed a PubMed search of all articles published in English on CDCs. Data captured include demographics, clinical presentations, investigations, management modalities, complications, and outcomes. Fourteen major series (10 or more than 10 cases) and 89 isolated case reports/series on CDCs with a collective patient pool of 1,063 were studied in detail. Specific emphasis was laid on addressing the controversial issues including initial conservative versus surgical management and the role of endoscopic evaluation.

RESULTS

Numerous terminologies have been used to describe CDC. Congenital dacryocystoceles are rare variants of congenital nasolacrimal duct obstructions and comprise of 0.1% to 0.3% of all such cases. There is a female predilection (64.2%, 683/1,063) and the mean age at presentation is at 7 days of birth. Initial conservative treatment can be a viable option in the absence of an acute dacryocystitis or a respiratory distress. Endoscopy-assisted probing appears to have better outcomes as compared with the in-office probing. Congenital dacryocystoceles with acute dacryocystitis are preferably managed with intravenous antibiotics and an early probing under endoscopy guidance to avoid missing intranasal cysts. Marsupialization is the preferred technique in the management of intranasal cysts. Silicone intubation was rarely used and has no definitive indications. Dacryocystorhinostomy is very rarely needed in the management of CDC.

CONCLUSIONS

Congenital dacryocystocele is a commonly accepted term and its use should be advocated to enhance uniformity in reporting. Endoscopic evaluation of CDC is useful in the diagnosis and treatment of associated intranasal cysts and enhances the rates of successful outcomes.

Conservative management of congenital dacryocystocele: resolution and complications

OBJECTIVE

To investigate the clinical outcomes of initial conservative management in infants with congenital dacryocystocele.

DESIGN

Retrospective case series.

PARTICIPANTS

A total of 30 congenital dacryocystoceles of 28 Korean infants treated between January 2006 and December 2015.

METHODS

All patients were managed conservatively with lacrimal sac massage. Clinical courses and outcomes of the patients were retrospectively reviewed, and rates of resolution of dacryocystoceles and development of dacryocystitis were analyzed.

RESULTS

In 27 cases of dacryocystoceles without infection, spontaneous resolution was achieved without any complication in 20 of 27 (74.1%) cases after conservative treatment. The mean duration of treatment was 27.5 days. Lacrimal probing was needed in 5 (18.5%) dacryocystoceles that persisted despite lacrimal sac massage for more than 1 month. Infectious dacryocystitis developed in 2 of 27 (7.4%) cases. Three dacryocystoceles were infected at presentation. Overall, 5 dacryocystoceles were complicated with infection and those cases received prompt systemic antibiotics treatment. External incision and drainage of the lacrimal sac was needed in 3 dacryocystoceles, and all cases were finally resolved without any additional procedures.

CONCLUSIONS

In this case series, most of the uninfected dacryocystoceles could be successfully managed with conservative treatment alone. In cases with infection, systemic antibiotics were essential and external drainage was sometimes required, but these cases could be conservatively managed after the remission of infection.

A rare cause of intermittent respiratory distress and epiphora in the newborn: congenital dacryocystocele

Congenital dacryocystocele is a malformation of the nasolacrimal system. Most of the cases can be successfully treated with conservative treatment options such as sac massage. Congenital dacryocystoceles with concomitant intranasal cysts causing respiratory distress in the newborns are rarely published. In this case report we presented a 2-week-old newborn with bilateral congenital dacryocystoceles causing intermittent respiratory distress. We discuss the importance of nasal endoscopic treatment and multidisciplinary approach for these rare malformations in the light of the current literature.

Dacryocystocele on prenatal ultrasonography: diagnosis and postnatal outcomes

Purpose:

To report the incidence of dacryocystoceles detected by prenatal ultrasonography (US) and their postnatal outcomes and to determine the factors associated with the postnatal persistence of dacryocystoceles at birth.

Methods:

We retrospectively reviewed the prenatal US database at our institution for the period between January 2012 and December 2013. The medical records of women who had fetuses diagnosed with dacryocystocel larger than 5 mm were reviewed for maternal age, gestational age (GA) at detection, size and side of the dacryocystoceles, delivery, and postnatal information, such as GA at delivery, delivery mode, and gender of the neonate.

Results:

A total of 49 singletons were diagnosed with a dacryocystocele on prenatal US, yielding an overall incidence of 0.43%. The incidence of dacryocystoceles was the highest at the GA of 27 weeks and decreased toward term. Of the 49 fetuses including three of undeter mined gender, 25 (54%) were female. The mean GA at first detection was 31.2 weeks. The dacryocystocele was unilateral in 29 cases, with a mean maximum diameter of 7 mm. Spontaneous resolution at birth was documented in 35 out of 46 neonates (76%), including six with prenatal resolution. Multivariate analysis demonstrated that GA at delivery was a significant predictor of the postnatal persistence of dacryocystoceles (P=0.045).

Conclusion:

The overall incidence of prenatal dacryocystoceles was 0.43%; the incidence was higher in the early third trimester and decreased thereafter. Prenatal dacryocystoceles resolved in 76% of the patients at birth, and the GA at delivery was a significant predictor of postnatal persistence.