A case of combination of dacryocystocele with a nasolacrymal cyst in infant child

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Abstract

INTRODUCTION: Dacryocystocele (hydrops of the lacrimal sac) is a rare variant of a congenital pathology caused by the obstruction of proximal and distal lacrimal ducts, followed by progressive distension of the lacrimal sac [1]. Given the accumulation of abundant contents in the lacrimal sac and nasolacrimal duct, the membrane that closes their outlet under the inferior turbinate can be stretched, and the prominence of such a membrane into the inferior nasal passage is in the form of the so-called nasolacrimal cyst [3].

Description of the clinical case. A 1.5-month-old girl was hospitalized in the ophthalmology department of the University. Below are the history data. At the 30th week of pregnancy, the fetus had a bilateral space-occupying lesion in the area of the inner canthus of the eye. At birth, the child had a dense swelling in the region of the left lacrimal sac but without discharge. From birth, he had difficulty in nasal breathing.

RESULTS: According to the results of multislice computed tomography of the lacrimal ducts with contrast (Ultravist), cavity formations were found under the inferior turbinate on both sides with a contrast level. At the age of two months, the child, accompanied by an otolaryngologist, underwent surgery for the removal of nasolacrimal cysts on both sides and reconstruction of the lacrimal ducts and their intubation with a silicone thread on the left. After surgical treatment, the outflow of tears and nasal breathing were restored, and no signs of dacryocystocele were detected. The silicone thread was removed after 1 month, and no tear production was observed.

DISCUSSION: Treatment of children with dacryocystocele involves the simultaneous reconstruction of lacrimal ducts by an ophthalmologist and excision of the nasolacrimal cyst by an otolaryngologist.

CONCLUSION: When examining a child with dacryocystocele, the possible presence of a nasolacrimal cyst should be considered. The interaction of an ophthalmologist and an otolaryngologist at all stages of the treatment and diagnostic process enables the prevention of disease complications and unnecessary surgical procedures.

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About the authors

Natalia V. Prisich

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: prisichnv@rambler.ru
ORCID iD: 0000-0001-7749-7850
SPIN-code: 2137-7429

MD, ophthalmologist

Russian Federation, St. Petersburg

Vladimir V. Brzheskiy

St. Petersburg State Pediatric Medical University

Email: vvbrzh@yandex.ru
ORCID iD: 0000-0001-7361-0270
SPIN-code: 5442-0989

MD, Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

Vyacheslav A. Verezgov

St. Petersburg State Pediatric Medical University

Email: verezgov@gmail.com
ORCID iD: 0000-0001-5049-916X
SPIN-code: 2476-8880

MD, PhD

Russian Federation, St. Petersburg

Pavel V. Pavlov

St. Petersburg State Pediatric Medical University

Email: pvpavlov@mail.ru
ORCID iD: 0000-0002-4626-201X
SPIN-code: 3675-9650

MD, Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

Elena L. Efimova

St. Petersburg State Pediatric Medical University

Email: elena.efi@mail.ru
ORCID iD: 0000-0003-2381-8385
SPIN-code: 8198-8976

MD, PhD, Assistent Professor

Russian Federation, St. Petersburg

Natalya N. Sadovnikova

St. Petersburg State Pediatric Medical University

Email: natasha.sadov@mail.ru
ORCID iD: 0000-0002-8217-4594
SPIN-code: 4537-9231

MD, PhD

Russian Federation, St. Petersburg

References

  1. Sakovich VN, Serdyuk VN, Klopotskaya NG, Tarnopolskaya IN. The effectiveness of drainage of the lacrimal sac in dacryocystocele in newborns. Medical perspectives (Medicni Perspektivi), SE ”Dnipropetrovsk medical academy of Health Ministry of Ukraine”. 2016;21(4):49–53. (In Russ).
  2. Brzheskii VV. Patologiya sleznogo apparata u novorozhdennykh. In: Brzheskii VV, Ivanov DO, editors. Neonatal’naya oftal’mologiya. Rukovodstvo dlya vrachei. Moscow: GEOTAR-Media; 2021. P:127–164. (In Russ).
  3. Cavazza S, Laffi GL, Lodi L, et al. Congenital dacryocystocele: diagnosis and treatment. Acta Otorhinolaryngol Ital. 2008;28(6):298–301. PMC2689544
  4. Veropotvelyan NP. Prenatal’naya ul’trazvukovaya diagnostika dakriotsistotsele. Prenatal’naya diagnostika. 2007;6(1):39–42. (In Russ).
  5. Kim YH, Lee YJ, Song MJ, et al. Dacryocystocele on prenatal ultrasonography: diagnosis and postnatal outcomes. Ultrasonography. 2015;34(1):51–57. doi: 10.14366/usg.14037

Supplementary files

Supplementary Files
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1. Fig. 1. Schematic representation of a nasolacrimal cyst.

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2. Fig. 2. Bilateral dacryocystocele (ultrasound at the 30th week of gestation).

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3. Fig. 3. Left-sided dacryocystocele on day 1 of life.

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4. Fig. 4. Edema and hyperemia in the area of the left lacrimal sac with purulent discharge in the conjunctival cavity.

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5. Fig. 5. Appearance of the left lacrimal sac area after probing (a) and dacryocystocele recurrence on the 10th day after the procedure (b).

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6. Fig. 6. Appearance of the left lacrimal sac area after its external opening (a) and on the 10th day (b).

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7. Fig. 7. Bilateral nasolacrimal cysts with accumulated contrast.

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8. Fig. 8. Nasolacrimal cyst showing an outflow of contrast agent during the compression of the lacrimal sac (a) and a “sealed” nasolacrimal cyst (b).

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9. Fig. 9. First day after the operation. The lacrimal pathways were intubated with a silicone thread, whose both ends were fixed with a patch to the skin of the cheek.

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10. Fig. 10. Appearance of the child at 1 month after surgical treatment.

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Свидетельство о регистрации СМИ ПИ № ФС 77 - 28266 от 17.05.2007 г. выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор). 
Свидетельство о регистрации СМИ ЭЛ № ФС 77 - 80630 от 15.03.2021 г. выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).


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