Discussion

Congenital dacryocystocele incidence varies from 1% to 12%.1 Even though congenital dacryocystocele swelling presents inferior to medial canthal tendon, it needs to be differentiated from some of the important clinical conditions which may present at birth or soon after that usually situated below the medial canthal tendon, these include capillary haemangioma, encephalocele, internal angular dermoid, mucocele, sebaceous cyst and others. Clinical examination of the dacryocystocele will be soft to firm swelling. Although congenital nasolacrimal lacrimonasal duct is common in newborns, but dacryocystocele is uncommon. It is secondary to blockage in the distal end of the nasolacrimal duct leading to a cystic dilation. The diagnosis can be quite challenging based on clinical features because if it is cystic swelling just inferior to the medial canthus, it can be suspected easily, but some cases tend to present with nasal obstruction or respiratory distress in the newborn. A sound clinical observation, periorbital ultrasonography, endoscopic nasal examination and meticulous use of CT or MRI imaging play a key role in diagnosis. Nasal cavity examination is important to rule out any intranasal extension of the swelling or deviation of inferior nasal turbinate due to lower part dacryocystocele. The management of a congenital dacryocystocele is controversial; conservative management is usually followed initially which includes lacrimal sac massage, which increases the hydrostatic pressure within the lacrimal sac in turn leading to drainage of the contents into the nose, warm compresses, topical antibiotic drops and systemic antibiotics to avoid secondary infection.2 ,3 Therapeutic probing is indicated in cases which are not relieved of symptoms by conservative methods and development of dacryocystitis to prevent subsequent preseptal/orbital cellulitis and sepsis.3