Clinical case of late complication of congenital dacryocystitis

Abstract

A clinical case is presented in a 62-year-old patient. Based on anamnesis, the patient had congenital dacryocystitis, for which repeated probing was performed at the age of 24 years. This treatment did not have a positive effect. Irregular conservative treatment and prolonged self-message of the lacrimal sac area resulted in complications: a significantly enlarged lacrimal sac, difficulty in moving the eyeball, double vision, and pronounced discomfort. Objectively, the patient had a tense moderately painful formation in the area of the inner corner of the eye slit, which displaced and deformed the lower eyelid. The right eye was deflected outward to 78 Girshberg, its mobility was significantly limited in the inner and lower-inner part and slightly limited in the lower part. On computed tomography, the lacrimal sac significantly shifted into the orbit, the posterior part of the lacrimal sac was located behind the equator of the eyeball, and the size of the lacrimal sac was 1.5 times that of the eye. The enlarged lacrimal sac (dacryocele) induced the deviation of the eyeball outward with the appearance of diplopia. The lacrimal sac was removed by radio wave surgery: after the skin incision and separation of the fibers of the circular muscle, the lacrimal sac was opened, and 6.5 mL of liquid contents were evacuated from it. The walls of the bag were clamped, and delicately with the tip of the radio wave device, the lacrimal sac was completely isolated from the surrounding tissues. The wound was sutured in layers. After the operation, the patient received standard anti-inflammatory treatment. The postoperative course proceeded without complications, and all the symptoms (diplopia, eyeball deviation, impaired mobility, and discomfort) were resolved from the first days after the operation.