Quiste congénito del conducto nasolacrimal/dacrio-cistocele: causa de dacriocistitis no diagnosticada / Congenital cyst of nasolacrimal duct/dacriocistocele: cause of non-diagnosed dacriocistitis

RESUMEN Se presenta dos casos de pacientes menores de 5 meses los cuales durante las primeras semanas de vida presentan descarga ocular muco-purulenta de manera recurrente. Posteriormente en la endoscopia se encuentra en los dos casos masas quísticas intranasales dando un diagnóstico de dacriocistocele más quiste congénito del conducto nasolagrimal. El dacriocistocele es una causa muy rara de obstrucción del conducto nasal y más raro cuando viene acompañado de un quiste congénito del conducto nasolagrimal. Debido a su rareza y a su sintomatología muchas veces atípica resulta en un diagnóstico complicado para el otorrinolaringólogo y para el oftalmólogo.

ABSTRACT Two cases of patients younger than 5 months are presented, who during the first weeks of life have recurrent muco-purulent ocular dis-charge. Subsequently, in endoscopy, in both cases, intranasal cystic masses were found, resulting in a diagnosis of dacryocystocele plus congenital cyst of the lacrimal duct. Dacryocystocele is an uncommon cause of nasal duct obstruction, but it becomes less common when accompanied by a congenital tear duct cyst. Due to its uncommonness and its often-atypical symptoms, it results in a complicated diagnosis for the ENT and the ophthalmologist.

Prenatal ultrasonic diagnosis and outcome of congenital dacryocystocele / 中华超声影像学杂志

Objective@#To explore the value of prenatal ultrasound in diagnosis of congenital dacryocystocele.@*Methods@#The ultrasonographic features of 16 fetuses with congenital dacryocystocele were retrospectively reviewed and the outcome of pregnancy were followed up.@*Results@#The median gestational week detected with prenatal ultrasound was 30.29 weeks, the mean diameter was (8.96±1.96)mm. Congenital dacryocystoceles were unilateral in 12 fetuses and bilateral in 4 fetuses, 10 were female and 6 were male. The typical ultrasonic feature was anechoic cystic mass with clear boundary in relation to the medial and inferior aspects of the fetal orbit. The dacryocystocele resolved spontaneously prenatally in 5 fetuses, resolved spontaneously after delivery in 10 fetuses. One fetus died in caesarean section due to complete placenta previa.@*Conclusions@#Congenital dacryocystitis has its characteristic ultrasonographic features, and most cases can disappear naturally in prenatal or early newborns.

Dacriocistocele no adulto / Adult dacryocystocele

A dacriocistocele representa um saco lacrimal dilatado e é frequentemente considerada como tendo uma etiologia congênita. No entanto, dacriocistocele é uma doença rara em adultos. A característica clínica se caracteriza por um abaulamento indolor na região medial da órbita, inferior ao ligamento cantal medial. O teste de excreção lacrimal, endoscopia, tomografia computadorizada e ressonância magnética são utilizados para fazer o diagnóstico de dacriocistocele. Semelhante a pacientes pediátricos, marsupialização endoscópica do cisto nasal e a colocação de stent parece ser a terapêutica adequada. Em alguns casos o tratamento consiste na dacriocistorrinostomia externa.

The dacryocystocele represents a dilated lacrimal sac and is often considered as having a congenital etiology. However, dacryocystocele is a rare disease in adults. The clinical feature is characterized by a painless bulge in the medial region of the orbit, below the medial canthal ligament. The lacrimal excretion test, endoscopy, computerized tomography and magnetic resonance image are used to make the diagnosis of dacryocystocele. Similar to pediatric patients, endoscopic marsupialization of the cyst with nasal stenting seems to be the appropriate therapy. In some cases the treatment consists of external dacryocystorhinostomy.

A Case of Acquired Dacryocystocele Treated by Lacrimal Silicone Intubation

PURPOSE: To report a case of an acquired dacryocystocele successfully treated with bicanalicular silicone intubation and to review relating literature. CASE SUMMARY: A 17-year-old girl visited our clinic with tearing of both eyes since birth and a mass on the right medial canthal area for 2 years. A firm, non-tender mass with a well-demarcated border was palpated in the subcutaneous level just inferior to the right medial canthal ligament. Lacrimal irrigation via the lower punctums showed reflux through the opposite punctums without nasal passage in both of her eyes. Computed tomographic scan showed a widening of the right lacrimal sac fossa and bony nasolacrimal canal and a 16 x 18 mm sized cyst-like mass in the right lacrimal sac. The patient was diagnosed with right acquired dacryocystocele associated with bilateral congenital nasolacrimal duct obstructions. After opening of the obstructed common canaliculus using a fine lacrimal probe, silicone intubation was performed. The tearing symptom improved and the mass disappeared during the subsequent follow-up period of 1 year. CONCLUSIONS: When only accompanied by distal nasolacrimal duct obstruction, acquired dacryocystocele can be inferred to be associated with congenital nasolacrimal duct obstruction. Subsequently, bicanalicular silicone intubation can be considered as a treatment of choice.

Dacryocystocele in Adult: A Report of Five Cases

PURPOSE: To report the clinical findings and the treatments of patients with dacryocystocele, presenting as an uncommon mass in the medial canthal area of adults. CASE SUMMARY: Five patients, diagnosed with dacryocystocele, complained of epiphora and mucopurulent discharge and were found to have a medial canthal mass. Four of these patients presented with symptoms of acute dacryocystitis. One patient underwent repeated endonasal dacryocystorhinostomy (endonasal DCR) with silicone implantation, but the epiphora returned a few months after the treatment. The patient then received external dacryocystorhinostomy (external DCR) with silicone implantation. Two patients experienced recurrence after the first endonasal DCR and, therefore, received repeat endonasal DCR with silicone implantation via a maximum excision of the enlarged lacrimal sac. One patient underwent external DCR with silicone implantation due to acute inflammation with chronic dacryocystitis, and one attempted conservative treatment after refusing any surgical procedure but suffered a relapse. In the surgical cases, no patients experienced recurrence after the final procedure, and they all had a favorable course during the 6 to 14 months of follow-up. CONCLUSIONS: Dacryocystocele in adults always requires a surgical procedure. Additional maximum excision of the lateral wall of an enlarged lacrimal sac could be performed to reduce the possibility of recurrence.

A Case of Congenital Dacryocystocele

A 6-day-old infant presented with a deeply bluish cystic mass below the right medial canthus. She had been born healthy. Under the impression of a hemangioma brain computed tomography was conducted. As a result, a diagnosis of congenital dacryocystocele was made. We present this case to show that it is important for a dermatologist to correctly identify congenital dacryocystoceles and appropriately refer the infant to a pediatric ophthalmologist prior to performing invasive measures.

Two Cases of Nasolacrimal Duct Cyst Developed in Neonate

Bilateral nasolacrimal duct cyst is an uncommon disease causing respiratory and feeding difficulty in neonates. It can either present pure intranasal cystic mass or be associated with dacryocystocele and/or dacryocystitis. Symptoms and signs of nasolacrimal duct cyst are different according to the patient's age and its bilaterality. Therefore, treatment should be individualized according to its presentation. The authors experienced one case of bilateral nasolacrimal duct cyst without dacryocystocele which caused respiratory difficulty and another case of nasolacrimal duct cyst associated with dacryocystocele. Both cases were treated by endoscopic marsupializaion of the cysts. We report these two cases with a brief review of the literature.

A Case of Bilateral Congenital Dacryocystoceles with Nasolacrimal Duct Cysts

PURPOSE: Congenital dacryocystocele is an uncommon variant of congenital nasolacrimal duct obstruction. We report a case of infected congenital dacryocystoceles with nasolacrimal duct cysts bilaterally. METHODS: A 5-day-old girl had bilateral bluish swellings over the lacrimal sacs. Although she had been treated with systemic antibiotics, antibiotic eyedrops and massage, the swelling was not reduced. A computed tomographic (CT) scan demonstrated distension of both lacrimal sacs and nasolacrimal ducts with soft tissue masses beneath the inferior turbinates bilaterally. RESULTS: After marsupialization of bilateral nasolacrimal duct cysts under nasal endoscopic visualization, the swellings over both lacrimal sacs were rapidly resolved without recurrence 3 months thereafter.

A Case of Bilateral Dacryocystocele with Absence of the Lacrimal Puncta

A 33-year-old female suffered from bilateral mass in the medial area and epiphora for 20 years. The mass recurred after incomplete removal several times. Ocular examination showed that the puncta and papillae of the both lower and upper lids were completely missing. At operation, there was obstruction in the bony portion of the nasolacrimal duct. The mass was a distended lacrimal sac. The lacrimal sac and the mucosa of the nasolacrimal duct were compJetely excised in the right side. The excision of lacrimal sac and mucosa of the nasolacrimal duct and conjunctivo-rhinostomy using Jones tube were performed in the left side. Nine months after operation, the patient was happy with the results and there was no recurrence.