Process of spontaneous resolution in the conservative management of congenital dacryocystocele

Abstract

Masashi Mimura,1,2 Mari Ueki,1 Hidehiro Oku,1 Bunpei Sato,2 Tsunehiko Ikeda11Department of Ophthalmology, Osaka Medical College, Takatsuki, 2Department of Ophthalmology, Osaka Kaisei Hospital, Osaka, JapanPurpose: To assess efficacy of the conservative management of patients with congenital dacryocystocele.Materials and methods: This was a retrospective case series involving six sides of five infants with a dacryocystocele treated at Osaka Kaisei Hospital, Osaka, Japan. The conservative management protocol consisted of the application of warm compresses and massage over the mass, with the addition of antibiotics when dacryocystitis developed. Patient age at the time of resolution, presence of retrograde outflow of contents of dacryocystoceles from the puncta, and development of dacryocystitis were recorded.Results: The dacryocystocele was unilateral in four patients and bilateral in one patient. A nasal cyst was present in four patients without respiratory distress. The median patient age at the time of the diagnosis was 7 days (range 2–10 days). Conservative management was selected in all patients, and the dacryocystocele was resolved in all patients at a median patient age of 14.5 days (range 11–105 days). Two sides developed dacryocystitis, which resolved in a few days with antibiotic treatment. In those two sides, rupture of the dacryocystoceles to the common canaliculus with retrograde discharge of the contents from the puncta before the dacryocystitis developed was noted. For the other four treated sides, no such discharge or development of dacryocystitis was observed.Conclusion: The findings of this study show that a dacryocystocele has a good chance of resolving spontaneously with conservative management and careful observation, and that rupture of the dacryocystocele to the common canaliculus might be an important precursor of dacryocystitis.Keywords: dacryocystitis, congenital lacrimal obstruction, remnant, precursor, retrograde discharge