• Oculoplastics/Orbit

    This prospective study describes the incidence and presenting features of congenital dacryocystocele in the United Kingdom.

    Study design

    The researchers identified cases of congenital dacryocystocele via the British Ophthalmology Surveillance Unit (BOSU) reporting system. They included infants younger than 3 months who presented with cystic swelling at the medial canthus between September 2014 and October 2015.

    Outcomes

    The study included 49 patients with an average age at presentation of 17 days. Of these cases, 91% were unilateral, 49% had dacryocystitis and 17% had respiratory distress.

    Conservative measures were effective in 86% of patients. Surgery was performed in 23% of patients, most commonly in those with dacryocystitis or nasal obstruction. Digital massage appeared to decrease the need for surgical intervention.

    Limitations

    Although this study was prospective, cases were identified via a reporting system that relies on questionnaires. Consequently, the study was limited by a 71% reporting rate, subjective indications for surgical intervention and non-uniform criteria for defining dacryocystitis and respiratory distress.

    Clinical significance

    The literature is sparse with regards to guidelines for the treatment of congenital dacryocystocele. This study confirms the suggestion that massage is useful in decreasing the likelihood of surgical intervention. It also supports surgical intervention in cases of dacryocystitis that do not respond to antibiotics, and in patients who develop respiratory distress.