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ABSTRACT
Purpose: To study prospectively the effectiveness of medical management of congenital dacryoceles.
Methods: All patients presenting with congenital dacryocele that were not infected were treated with warm compresses, massage, and topical antibiotics. Dacryoceles that did not resolve with at least two weeks of medical management were probed. Dacryoceles that were infected were treated with intravenous (IV) antibiotics in addition to warm compresses and massage.
Results: Seventeen patients with 21 dacryoceles were studied over a 3 1/3-year period. All patients were examined by the authors and treatment was initiated prior to 3 weeks of age. Sixteen dacryoceles resolved with medical management in 1 to 6 days. Three of these 1 6 dacryoceles were infected and patients were hospitalized at the time of initial ophthalmic evaluation (2 to 4 days of life). One additional dacryocele became infected after 2 days of medical management (4th day of life), requiring hospital admission and IV antibiotics. All four infected dacryoceles resolved within 24 hours of the initiation of IV antibiotics, warm compresses, and massage. Five dacryoceles were probed after not resolving within 14 to 31 days of medical management. One dacryocele required a repeat probing.
Conclusions: Medical management can be effective in the treatment of congenital dacryoceles; 76% of dacryoceles in this series resolved after 6 days of medical management.
INTRODUCTION
Congenital nasolacrimal duct obstruction typically involves a blockage at the valve of Hasner. It is frequently present at birth.1,2 Infrequently, it may occur in association with a blockage at the point where the canaliculi join the tear sac, giving rise to a distended tear sac.3 The most popular term used to describe this entity is congenital dacryocele, but it has also been referred to as amniotocele, aminocele, mucocele, or dacryocystocele. Treatment of this disorder has been controversial. Some authors advocate a trial of medical management,4-8 while others advocate immediate probing to prevent infection.9-12 We undertook a prospective trial of at least 2 weeks of medical care in the treatment of congenital dacryoceles.
MATERIALS AND METHODS
AD patients younger than 4 weeks who presented to the authors with dacryocele were included in this study. On the initial evaluation, the age at which the dacryocele was first noted by the family and referring physician was elicited. An attempt...