ASOPRSFall Scientific SymposiumSyllabus
134
Orbit Session III
Moderator:Timothy J.McCulley,MD
3:45pm
Orbital andPeriorbital Extensionof Congenital Dacryocystoceles
FrancescoBernardini
1
, AltugCetinkaya
2
, JamesKatowitz
3
, PelinKaynak
4
.
1
OculoplasticaBernardini, Genova, Italy,
2
Ophthalmology, Dunyagoz AnkaraHastanesi, Ankara, Turkey,
3
Ophthalmology, TheChildren’sHospital of Philadelphia,
Philadelphia, PA, UnitedStates,
4
Ophthalmology, Istanbul BeyoğluEyeResearchHospital, Istanbul, Turkey
Introduction:
To describe the clinical presentation and successful surgical management of four cases of congenital dacryocystocele
that presentedwith extension to the orbital and periorbital regions.
Methods:
Retrospective chart review of four cases that were diagnosed and surgically treated for orbital and/or periorbital
dacryocystocele extensions.The first casewas a 12 day-old newborn presentingwith acute proptosis of the left eye secondary
to complete orbital invasion of a congenital dacryocystocele.The second casewas a 40 days old femalewith an anterior
dacryocystocele that showed initial signs of orbital expansion and globe compression.The third casewas a 9 day-old girl newborn
with a prominent dacryocystocele of the lacrimal sac that developed into an acute cystic expansion and infection of the anterior lower
orbit, lower eyelid and upper cheek immediately following overly forceful sacmassage by the primary care physician.The fourth
patient was a 7-month-old infant with a history of recurrent episodes of acute dacryocystitis that began several weeks after birth and
on presentation demonstrated a large dacryocystocele extending toward the orbit and ethmoid sinus.
Results:
The first three newbornswere brought immediately to the surgical theater after radiographic evidence of diffuse orbital or
periorbital expansion. Prompt surgical interventionwithmarsupialization of the orbital and periorbital dacryocystocelewith aspiration
of the purulent material followed by nasolacrimal duct probing resulted in complete resolution of the clinical picture in both patients.
No cyst recurrence or lacrimal drainage problemswere seen during follow-up.The fourth patient was successfully treatedwith an
external dacryocystorhinostomy (DCR) with excision of the enlarged cysticwalls.
Conclusions:
Orbital and periorbital extension of congenital dacryocystoceles is rarely observed in neonatal infants.Trans-
conjunctival orbitotomywith sacmarsupialization followed by naso-lacrimal intubation can provide immediate and permanent
resolution of this unusual complication inmost instances. External DCRmay be required, however,when the orbital or periorbital
dacryocystocele is complicated by acute or recurrent dacryocystitis.
References:
1. Sevel D. Development and congenital abnormalities of the nasolacrimal apparatus. J Pediatr Ophthalmol Strabismus
1981; 18:13-9.
2. Harris GJ, DiClementi D. Congenital dacryocystocele.ArchOphthalmol 1982; 100:1763-5.
3. Becker BB.The treatment of congenital dacryocystocele.Am JOphthalmol 2006; 142:835-8.
4. Shekunov J, GriepentrogGJ, Diehl NN,Mohney BG. JAAPOS2010; 14:417-20
5.Wong RK,VanderVeenDK. Presentation andmanagement of congenital dacryocystocele. Pediatrics 2008; 122:e1108-12.
6. Schnall BM, ChristianCJ. Conservative treatment of congenital dacryocystocele. J Pediatr Ophthalmol Strabismus 1996;
33:219-22.
DetailedProgram
—Friday,October 17, 2014
