Pseudodacryocystitis: paediatric case series of infected atypical ethmoid air cells masquerading as recurrent dacryocystitis

PurposeTo highlight the clinical and surgical considerations in treating patients with apparent recurrent acute dacryocystitis with a patent lacrimal system.MethodsThree children referred to a tertiary unit as recurrent acute dacryocystitis were reviewed retrospectively. Imaging and subsequent surgical intervention revealed the underlying diagnosis.ResultsAll three cases presented with recurrent abscesses in the region of the lacrimal sac that failed to respond to incision and drainage. The lesions were lower and more lateral to the usual location of a sac abscess and closer to the inferior orbital rim. All three cases were found to have patent lacrimal systems on syringing, and all were found to have infected, low-lying, anteriorly placed aberrant ethmoid air cells on computed tomography and magnetic resonance imaging. These were confirmed on subsequent surgical exploration.ConclusionsInfected low-lying ethmoid air cells can mimic dacryocystitis with recurrent abcesses. In cases where a patent nasolacrimal system is demonstrated and a more inferolateral location of the swelling than would be expected in dacryocystitis is seen, imaging is warranted to ensure the appropriate intervention is undertaken. Anterior ethmoidectomy as opposed to dacryocystorhinostomy is the appropriate treatment in these cases.

Sub-Tenon's local anaesthesia for the treatment of retinopathy of prematurity with diode laser

PURPOSE

To evaluate the safety and efficacy of sub-Tenon's local anaesthesia (LA) for laser treatment of threshold retinopathy of prematurity (ROP).

METHODS

A cohort of 18 eyes of 10 neonates with threshold ROP was treated with diode laser peripheral retinal ablation over 14 treatment sessions using oral sedation and sub-Tenon's anaesthesia. Treatment was performed in a neonatal unit. The heart and respiratory rate, trans-cutaneous oxygen saturation, and physical activity were continuously monitored for signs of neonatal distress. Cardio-respiratory stability during and after the procedure was scored for each eye treated using a Cardio-respiratory index described previously.

RESULTS

In all cases, the planned dose of laser was delivered. One out of 18 eyes developed stage 4b tractional retinal detachment over a follow-up of at least 6 months for all babies. Systemic complications during treatment included transient bradycardia and apnoea requiring stimulation in two babies and excessive head mobility in three babies. Treatment duration varied between 20 and 80 min. Ocular complications were conjunctival haemorrhage and chemosis. The mean cardio-respiratory index was 1.13, which compared favourably with the standard published.

CONCLUSIONS

Sub-Tenon's LA with oral sedation appears to be a safe and effective alternative to general anaesthesia for laser treatment of ROP, with the potential for lower morbidity.