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| LETTER TO EDITOR |
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| Year : 2017 | Volume
: 10
| Issue : 2 | Page : 124-126 |
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A rare case of bilateral congenital dacryocele
Gauri Bhushan, Usha Kaul Raina, Mahendra Gorey Apurva, Rathie Neha
Department of Ophthalmology, Guru Nanak Eye Centre, New Delhi, India
| Date of Web Publication | 29-Jun-2017 |
Correspondence Address:
Gauri Bhushan
B-3/75-B, Lawrence Road, New Delhi 110 035
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ojo.OJO_41_2016
How to cite this article:
Bhushan G, Raina UK, Apurva MG, Neha R. A rare case of bilateral congenital dacryocele. Oman J Ophthalmol 2017;10:124-6 |
Sir,
Congenital dacryocele is an uncommon congenital anomaly characterized by bluish-gray cystic swelling of lacrimal sac seen just below the medial canthal tendon.[1] It is also referred to as congenital dacryocystocele, amniotocele, and mucocele. The condition is usually unilateral and has a female preponderance. It is typically present at birth and occurs due to concomitant obstruction of lacrimal system below the lacrimal sac and at the level of canalicular opening in the sac. There occurs entrapment of fluid nature, of which is debatable. Some reports point to the source as amniotic fluid; however, some studies propose it to be mucus produced by intraluminal goblet cells.[2] Diagnosis can be made on the basis of time of onset, appearance, ultrasound, computed tomography, or a magnetic resonance imaging to differentiate it from meningoencephalocele, capillary hemangioma, and dermoid cyst. The swelling resolves spontaneously in majority of cases with conservative management however when self-resolution fails to occur early probing is warranted to prevent the risk of dacryocystitis.
Authors would like to bring to notice a rare case of bilateral congenital dacryocele encountered in our clinical practice. A 5-day-old female infant born at term was brought to the OPD with bilateral tense blue cystic swelling below the medial canthus [Figure 1]. Swelling was more marked on the left side. There was no history of watering, and the swelling appeared to be nontender. An otorhinolaryngologist opinion was sought and intranasal extension of swelling was ruled out. Diagnosis of uncomplicated bilateral congenital dacryocele was made and in the absence of evidence of respiratory distress child was initially advised conservative management in the form of compressive massage. A week later, there was complete resolution of swelling [Figure 2], and the child remained asymptomatic even at 6 months. | Figure 2: One week later, complete resolution of swelling following conservative management
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Cases of bilateral dacryocele are rarely reported in literature.[2],[3] The few reported bilateral cases have demonstrated coexistent intranasal mucocele requiring surgical management. In such cases, respiratory distress occurs especially during feeding due to nasal obstruction; therefore, a thorough nasal checkup, rhinoscopy particularly of inferior nasal meatus is warranted. Our case had a rare presentation of bilateral involvement in the absence of intranasal extension.
Several case studies have shown successful treatment of uncomplicated congenital dacryocele with conservative management alone [4] which includes antibiotics, warm compresses, and sac massage. Since tear production does not start immediately after birth children usually do not have epiphora but complications in the form of dacryocystitis, preseptal cellulitis, and intranasal involvement have been seen in as high as 60% of cases requiring hospitalization and subsequent surgical management.[2] Probing alone is not sufficient and intubation to ensure prolonged patency of lacrimal system is needed. In cases with intranasal extension, early surgical intervention is mandatory and includes marsupialization of the cyst to prevent its recurrence.
Because of strong association of bilateral dacryocele with intranasal mucocele and a high rate of complications, we recommend in all cases of congenital dacryocele, a prompt nasal examination, and close follow-up to aid in appropriate decision-making and management.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Mansour AM, Cheng KP, Mumma JV, Stager DR, Harris GJ, Patrinely JR, et al. Congenital dacryocele. A collaborative review. Ophthalmology 1991;98:1744-51.  [ PUBMED] |
| 2. | Paysse EA, Coats DK, Bernstein JM, Go C, de Jong AL. Management and complications of congenital dacryocele with concurrent intranasal mucocele. J AAPOS 2000;4:46-53. [ PUBMED] |
| 3. | Wong KM, Jachens AW, Bortz J, Moscatello A. Bilateral congenital dacryocystoceles with intranasal mucoceles in the neonate: Case report and review of literature. Open J Pediatr 2012;2:178-80. |
| 4. | Schnall BM, Christian CJ. Conservative treatment of congenital dacryocele. J Pediatr Ophthalmol Strabismus 1996;33:219-22. [ PUBMED] |
[Figure 1], [Figure 2]
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