Congenital dacryocystocele: sonographic evaluation of 11 cases

Is congenital dacryocystocele a benign, self-limited disorder? A review of the literature with four new cases

Congenital dacryocystocele (CD) is a rare disorder about which little is known. A nonsystematic review was performed with an addition of four new cases. Thirty-seven studies were reviewed. The mean gestational age at evaluation was 32 ± 1.09 weeks suggesting that CD is a disorder of late second and third trimester. The mean diameter of dacryocystocele was 7.5 ± 1 mm. The overall associated fetal anomaly rate was 10.7%. In-utero resolution, neonatal resolution, and surgical management was concluded in 62% (n = 108), 29% (n = 52), and 8% (n = 14), respectively. In conclusion, the need for surgical correction and rate of accompanying fetal anomaly was found high.

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.