Chapter 617 Disorders of the Lacrimal System
Dacryostenosis
A dacryocystocele (mucocele) is an unusual presentation of a nonpatent nasolacrimal sac that is obstructed both proximally and distally. Dacryocystoceles can be seen at birth or shortly after birth as a bluish subcutaneous mass just below the medial canthal tendon (Fig. 617-1). Initial treatment of dacryocystocele is usually conservative, involving massage/digital decompression of the lacrimal sac. If resolution of the dacryocystocele is not achieved with conservative management, the surgical probing may be beneficial. At times, the intranasal portion of the nasolacrimal duct becomes distended causing respiratory compromise. In a recent study, 9.5% of infants with dacryocystocele had related respiratory compromise. These infants benefit from early probing. Another associated complication of dacryocystocele is that of dacryocystitis/cellulitis. This requires systemic antibiotics, often with hospitalization. In the aforementioned study, 65% of infants with dacryocystocele developed dacryocystitis/cellulitis. Once the cellulitis has improved, the nasolacrimal system should be probed if spontaneous resolution has not occurred.
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