Nasal endoscopy in the treatment of congenital lacrimal sac mucoceles.
OBJECTIVE
To determine the incidence of intranasal cysts associated with lacrimal sac mucoceles and the cure rate with nasal endoscopic cyst marsupialization.


METHODS
Interventional case series.


METHODS



METHODS
University-affiliated teaching hospital.


METHODS
Twenty-five infants with non infected or infected lacrimal sac mucoceles or dacrocystitis without obvious mucocele were consecutively enrolled. INTERVENTION PROCEDURES: Management included local lacrimal massage, parenteral antibiotics, and when still symptomatic, nasolacrimal duct probing with concomitant nasal endoscopy. Intranasal cysts identified were marsupialized until the distal end of the nasolacrimal duct probe was visualized.


METHODS
Presence of intranasal cyst identification and cure rate.


RESULTS
Infants were 4 days to 10 weeks old (mean 19 days). Forty-eight percent had a bluish cutaneous mass inferior and lateral to the lacrimal sac. Twenty percent were bilateral. At presentation, 76 percent had dacrocystitis. Fourteen percent had respiratory distress. Only one child responded to medical management. At endoscopy, 23 of 24 infants had ipsilateral intranasal cysts. The one child without nasal cyst had recurrent dacrocystitis and no mucocele. All children with mucocele were cured except one child with residual nasolacrimal duct obstruction.


CONCLUSIONS
Lacrimal sac mucoceles were almost always associated with intranasal cysts. Nasal endoscopy is a valuable addition to the treatment plan for lacrimal sac mucoceles not responding to a brief trial of massage or infantile dacrocystitis. To avoid potential complications, we recommend against waiting until infection occurs before proceeding with surgery.
Levin
Alex V
AV
Department of Ophthalmology, The Hospital for Sick Children, University of Toronto, Toronto, Ont, Canada M5G 1X8.
Wygnanski-Jaffe
Tamara
T
Forte
Vito
V
Buckwalter
Jeffrey A
JA
Buncic
J R
JR
D003607:Dacryocystitis / Q000151:congenital* / Q000473:pathology / Q000601:surgery*; D003608:Dacryocystorhinostomy; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007767:Lacrimal Duct Obstruction / Q000151:congenital* / Q000473:pathology; D008297:Male; D009078:Mucocele / Q000151:congenital* / Q000473:pathology / Q000601:surgery*; D009296:Nasal Cavity / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results