A lacrimal duct cyst, or dacryocystocele, is a fluid-filled sac that forms when the tear drainage system is blocked. This system, the nasolacrimal duct, drains tears from the eyes into the nasal cavity. When obstructed, tears accumulate and create a cyst. This condition is most often seen in newborns if the duct doesn’t open properly after birth, but it can also develop in adults from infection, trauma, or inflammation.
Identifying Symptoms
The most prominent sign of a lacrimal duct cyst is a noticeable swelling near the inner corner of the eye, just below the eyelid. This lump often appears as a firm, smooth mass and may have a distinct bluish-gray color. The size of the swelling can sometimes fluctuate.
In addition to the visible swelling, excessive tearing (epiphora) is a common symptom, where the affected eye appears watery without an apparent cause like crying. A discharge of mucus from the eye can also occur, particularly if pressure is applied to the cyst.
In infants, a large cyst can pose additional challenges. The swelling may extend into the nasal passage, causing a physical obstruction. This can lead to noticeable breathing difficulties, especially during feeding, as babies primarily breathe through their noses. Any signs of respiratory distress in an infant with a suspected cyst warrant immediate medical attention.
The Diagnostic Process
A diagnosis begins with a physical examination. The provider will inspect the swelling at the inner corner of the eye and may gently press on the lacrimal sac. This action causing tears or a mucus-like discharge to come out through the small opening (punctum) in the corner of the eyelid confirms a blockage.
A visual inspection and patient history are often sufficient for diagnosis. If the diagnosis is uncertain or other conditions need to be ruled out, imaging tests may be used. An ultrasound is a common method to visualize the fluid-filled cyst, while a CT scan might be ordered for a detailed view of the surrounding structures.
Treatment Approaches
Initial treatment for a lacrimal duct cyst, particularly in newborns, often involves conservative methods. Caregivers are instructed to perform a gentle massage over the lacrimal sac in a downward motion toward the nose. This technique, combined with warm compresses, is intended to increase pressure and encourage the blockage to open spontaneously.
If conservative measures fail after a few weeks or if an infection develops, further intervention is needed. An infection, known as dacryocystitis, may require antibiotics. For a persistent blockage, a procedure called nasolacrimal duct probing may be recommended, where a thin, blunt instrument is passed through the tear duct to clear the obstruction.
For cases resistant to probing or for cysts that recur, surgical options are considered. A common procedure is an endoscopic dacryocystorhinostomy (DCR), where a surgeon creates a new drainage pathway from the lacrimal sac into the nasal cavity, bypassing the blocked duct. Most instances, especially in infants, are resolved with simpler treatments long before surgery is considered.