Dacryocystocele is a rare blockage within a baby’s tear drainage system. It typically presents as a bluish, firm lump near the inner corner of an infant’s eye. While it may appear concerning, dacryocystoceles are generally benign and often resolve on their own.
Understanding Dacryocystocele
Dacryocystocele represents a specific form of nasolacrimal duct obstruction, where fluid and mucus become trapped, resulting in a cyst-like swelling. This occurs due to blockages at two distinct points within the tear drainage pathway. There is an obstruction at the imperforate valve of Hasner, located at the distal end of the nasolacrimal duct, and a proximal obstruction, often involving the common canaliculus or Rosenmuller valve.
The accumulation of mucoid fluid within the lacrimal sac leads to its distension, forming the characteristic cystic structure. This condition is congenital, meaning it is present at birth, and it is usually unilateral, affecting one eye. The appearance is typically a tense, bluish-gray mass situated at the medial canthus, or inner corner of the eye.
Recognizing and Diagnosing Dacryocystocele
The affected eye may also appear watery, and some discharge might be present. A pediatrician or ophthalmologist typically diagnoses this condition through a physical examination.
In certain situations, imaging techniques such as ultrasound or computed tomography (CT) scans may be employed. While not routinely used for diagnosis, these imaging modalities can help confirm the cystic nature of the mass and differentiate it from other potential issues, especially if there are concerns about an intranasal extension of the cyst. Dacryocystoceles are distinct from simpler blocked tear ducts (dacryostenosis), which are more common and usually do not involve the characteristic cystic swelling.
Managing Dacryocystocele
Many dacryocystoceles resolve spontaneously as the infant’s tear drainage system matures, often within the first few weeks or months of life. Conservative management involves gentle massage techniques, which a doctor can demonstrate to parents. This massage aims to help clear the blockage by applying pressure to the lacrimal sac.
If conservative measures are not successful or if complications arise, medical intervention may become necessary. One common procedure is probing of the nasolacrimal duct, where a thin, flexible probe is gently inserted to open the blockage. In rare instances, if the dacryocystocele is large, causes respiratory distress due to intranasal extension, or becomes infected, surgical excision or marsupialization might be considered.
Potential Concerns and When to Seek Medical Attention
The primary concern with a dacryocystocele is the potential for infection, known as dacryocystitis. Signs of infection include increased redness, warmth, and swelling around the lump, along with the possible presence of pus or discharge from the eye. A fever or increased irritability in the baby can also indicate an infection.
An infected dacryocystocele requires immediate medical attention, as it may necessitate systemic antibiotics. Though rare, more serious complications like orbital cellulitis can develop if an infection is left untreated. Even without signs of infection, follow-up appointments with a healthcare professional are recommended to monitor the dacryocystocele’s resolution. The prognosis for dacryocystoceles is excellent, with most cases resolving without long-term issues.