Long-term Outcomes of a Minimally Invasive Surgical Approach in Paediatric Patients with Congenital Dacryocystoceles

Abstract

Introduction Congenital dacryocystoceles are a rare condition caused by nasolacrimal duct obstruction. Symptoms include epiphora, nasal obstruction, and swelling in the medial canthus. Treatment usually entails probing Hasnerʼs valve open and, if necessary, intubating the nasolacrimal duct. We present a minimally invasive, endoscopic procedure with marsupialisation of the endonasal portion of the cele. The operation avoids additional manipulation of the lacrimal duct to prevent iatrogenic injury.

Methods This retrospective analysis included a total of nineteen infants or young children (21 eyes) aged 3 days to 39 months. Two of the patients were suffering from acute respiratory distress, seven from recurrent infections with persistent epiphora, and twelve from acute dacryocystitis with orbital phlegmon.

Results The endonasal portion of the dacryocele was detected in all cases and resected endonasally using an endoscope. Recurrences required revision surgery involving dacryocystorhinostomy after primary surgery in two patients aged of 22 and 39 months. All other seventeen patients were free of recurrence.

Summary Our results show endoscopic endonasal marsupialisation without additional intubation or probing of the lacrimal ducts to be a successful treatment strategy for congenital dacryocystoceles. This avoids iatrogenic scarring, false passages, or postoperative bacteraemia. The surgical technique presented here shows a lower success rate in older children with a history of inflammation.

Fazit

Bereits bekannt:

• Dakryozystozelen stellen eine schwere Form der kongenitalen Tränenwegsobstruktion dar und haben eine nur geringe Tendenz zur Spontanheilung.

• Entzündungen oder klinisch relevanten Nasenatmungsbehinderungen können eine chirurgische Intervention erforderlich machen

Neu beschrieben:

• Mittels endoskopischer endonasaler Technik kann eine suffiziente Marsupialisation der Dakryozystozele erreicht werden. Die Heilungsrate in dem hier beschriebenen Kollektiv lag bei 90%.

• Auf eine zusätzliche Sondierung oder Schienung des Tränen-Nasen-Ganges kann verzichtet werden.

Conclusion

Already known:

• Dacryocystoceles are a severe form of congenital lacrimal duct obstruction and are unlikely to heal spontaneously.

• Inflammation and clinically relevant nasal respiratory obstruction may require surgical intervention.

New:

• Endoscopic endonasal techniques are suitable for sufficient dacryocystocele marsupialisation. The patient cohort in the present contribution reached healing rates of 90%.

• No additional probing or splinting in the nasolacrimal duct was required.

Keywords

dacryocystocele - endoscopic surgery - marsupialisation - paediatric ophthalmology

Publication History

Received: 18 April 2024

Accepted: 29 August 2024

Article published online:
05 December 2024

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