The authors report the first national study of dacryocystocoeles in UK. They report an incidence of one in 18,597 live births in the UK for congenital dacryocystocele. A prospective observational study of 49 cases of congenital dacryocystocele presenting between September 2014 and October 2015 was carried out. Infants <3 months of age, diagnosed with a cystic swelling in the medial canthal area reported to be a dacryocystocele and those diagnosed with congenital dacryocystitis, with or without a history of a cystic swelling were included. The average age at diagnosis was 16.94 days. The majority of patients were Caucasian, accounting for 80%. Most were females=54%. Almost all cases were full term (94%) with only 3% being premature and 3% not reported. There were 66% born via normal vaginal delivery, 6% were forcep assisted and 11% were born via caesarean section. No association could be determined between the mode of delivery and the presence of dacryocystitis. The majority (91%) of them were unilateral and many (55%) occurred on the right side. A lump was present in 100% of dacryocystoceles; 61% were reported to be bluish, 26% being red. Symptoms of nasal obstruction were reported in 17% of patients. Dacryocystitis was reported in 49% of patients. Evidence of nasal obstruction was present in 17%. Treatment modalities included observation (6%), massage (63%), antibiotics (77%) and surgical intervention (23%). The results suggest that uncomplicated dacryocystoceles are treated conservatively, and those complicated with dacryocystitis are treated initially with antibiotics followed by probing or endonasal decompression and marsupialisation if it failed to resolve. Massage appeared to reduce the likelihood of requiring surgical intervention, however, this is not statistically significant. Those patients with red lumps appeared more likely to have dacryocystitis and required subsequent surgical intervention (P=0.05). Recurrences were reported in 6%. Due to the serious nature of the condition it is recommended that those cases that do not respond to prompt conservative measures be referred to an appropriate centre for review by a paediatric ophthalmologist. It is recommended that a general paediatrician should also assess these infants, as the signs of respiratory distress due to nasal obstruction may be subtle. Limitations: This study was not designed to answer the questions of when the best time to intervene surgically is or what is the most appropriate method of surgical intervention.

The presentation, clinical features, complications, and treatment of congenital dacryocystocele.
Davies R, Watkins J W, Kotechka S, Watts P.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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