Complex CNLDO: Dacryocele

Abstract

Dacryocystocele or simply dacryoceles are bluish cystic lacrimal sac swelling, typically present in neonates, below the medial canthal tendon, filled with secretions from epithelial lining and tears. It is an uncommon manifestation of congenital nasolacrimal duct obstruction. CNLDO when combined with either functional obstruction of proximal lacrimal system or common canaliculus leads to accumulation of secretions in the lacrimal sac. This leads to distortion of common canaliculus and creates a ball-valve mechanism at the valve of Rosenmuller which allows ingress of tears into the sac but interferes with egress [1–5]. Dacryocystocele can be bilateral in 25% cases and can complicate into superadded infection and respiratory distress [1–5]. Associated intranasal cyst can be small or large (if >50 of nasal cavity) and if large, can cause respiratory insufficiency because neonates are nasal breathers, which can potentially be life threatening in cases of bilateral pathology.11 Infection can lead to preseptal cellulitis, orbital cellulitis, and sepsis and therefore indicating early management of this condition. In the absence of intranasal cysts, dacryocele can be managed conservatively, and the success rate achieved with sac compression alone was 76% in one of the series. In non-resolving cases and with associated intranasal cyst, it is preferable to marsupialize the intranasal cyst early [1]. Intranasal cysts are classified as small and large based on endoscopic features, and a technique of cruciate marsupialization has been found to be effective for large intranasal cysts with good long-term outcomes [1, 5].