OVERVIEW

What is congenital dacryocystocele?

Tears produced by the lacrimal gland flow across the eyeball to the inner eyelid, then into the lacrimal sac, and finally through the nasolacrimal duct into the nasal cavity. The pathway through which tears flow is commonly referred to as the "tear duct."

Congenital dacryocystocele occurs when both ends of the "tear duct" are blocked, causing substances such as amniotic fluid from the embryonic stage to accumulate in the lacrimal sac and nasolacrimal duct, unable to drain.

It primarily manifests as a blue swelling between the eye and nose at birth or shortly after, with a soft and fluctuant texture upon touch. Symptoms may also include excessive tearing and nasal congestion. Congenital dacryocystocele is particularly prone to infection, leading to eye redness, swelling, and purulent discharge.

Without treatment, congenital dacryocystocele rarely resolves on its own, and most affected infants may require probing of the tear duct.

Is congenital dacryocystocele common?

Congenital dacryocystocele is a relatively rare condition, with documented incidence rates of approximately 0.43%.

Is congenital dacryocystocele the same as congenital nasolacrimal duct obstruction?

No, they are different conditions.

• Congenital nasolacrimal duct obstruction occurs when the distal membrane of the nasolacrimal duct fails to open at birth, and most affected infants recover spontaneously within the first year of life.

• In congenital dacryocystocele, not only is the distal membrane of the nasolacrimal duct unopened, but the proximal opening of the common canaliculus is also blocked. This leads to the accumulation of substances like amniotic fluid in the nasolacrimal duct, making infection highly likely. Most affected infants require treatment to recover.

SYMPTOMS

What are the common manifestations of congenital dacryocystocele?

Congenital dacryocystocele typically presents symptoms at birth or shortly after, with a bluish swelling appearing in the area between the eye and nose, which feels elastic and fluctuant to the touch. Additionally, symptoms may include tearing without crying and nasal congestion.

How does congenital dacryocystocele develop?

Congenital dacryocystocele occurs when both sides of the duct connecting the eyelid to the nasal cavity are blocked, preventing amniotic fluid and infectious materials from draining through the nasolacrimal duct. These substances accumulate in the lacrimal sac between the eye and nose, forming a bluish cystic swelling.

Since amniotic fluid and other materials trapped in the lacrimal sac cannot drain, they become stagnant, promoting bacterial overgrowth and infection. This can eventually lead to severe conditions such as periorbital cellulitis or sepsis.

Additionally, the protruding lacrimal sac may compress the nasal cavity, impairing the infant's ability to breathe through the nose. Since infants cannot breathe through their mouths, this may result in respiratory distress or even suffocation.

What other diseases can congenital dacryocystocele cause?

Congenital dacryocystocele may lead to two potential complications: acute dacryocystitis, which in severe cases can cause periorbital cellulitis, sepsis, or meningitis; and respiratory distress or suffocation due to nasal obstruction.

What are the manifestations of acute dacryocystitis caused by congenital dacryocystocele?

• Redness and swelling of the eye;
• Increased skin temperature around the eyelid and lacrimal sac;
• Tenderness in the lacrimal sac;
• Pus-like discharge from the inner corner of the eye.

CAUSES

What causes congenital dacryocystocele?

The cause of congenital dacryocystocele is poor fetal development, where both the distal and proximal openings of the nasolacrimal duct become blocked, preventing substances like amniotic fluid from draining out of the lacrimal sac and nasolacrimal duct.

Who is commonly affected by congenital dacryocystocele?

Congenital dacryocystocele typically occurs in newborns or infants shortly after birth.

DIAGNOSIS

How should congenital dacryocystocele be diagnosed?

Doctors can usually diagnose congenital dacryocystocele through careful clinical examination. If a diagnosis cannot be made, a CT scan can be used for confirmation.

Which diseases is congenital dacryocystocele easily confused with?

Congenital dacryocystocele is easily confused with acute dacryocystitis, dermoid cysts in the medial canthus, and nasal masses. Doctors can differentiate them through orbital CT scans.

TREATMENT

Which department should I visit for congenital dacryocystocele?

Ophthalmology.

Can congenital dacryocystocele heal on its own?

Congenital dacryocystocele rarely resolves without treatment. The primary treatment method is surgery. However, some infants may gradually recover through non-surgical treatments (such as lacrimal duct irrigation and lacrimal sac massage). If the results are not significant, surgical intervention is still required.

How is congenital dacryocystocele treated?

Treatment for congenital dacryocystocele includes non-surgical and surgical methods.

• Non-surgical treatments include lacrimal duct irrigation, lacrimal sac massage, and antibiotic eye drops, which are suitable for cases without severe complications.
• Surgery is generally performed when non-surgical treatments fail, symptoms worsen, or severe infection occurs. Surgical options include lacrimal duct probing, endoscopic dacryocystorhinostomy, lacrimal duct intubation, and endoscopic cyst marsupialization.

How to perform lacrimal sac massage for congenital dacryocystocele during treatment?

Wash your hands and trim your nails before massaging. Apply gentle downward pressure on the lacrimal sac (located between the inner corner of the eye and the nose) for 2–3 seconds, repeating 2–3 times daily.

What precautions should be taken when using eye drops for congenital dacryocystocele?

• Mark the date of opening the eye drop bottle on the label. Do not use eye drops that have been opened for more than a month. Avoid using eye drops that have changed color or developed crystals in the bottle.

• Wash your hands thoroughly with soap or hand sanitizer and dry them before applying eye drops. Avoid contaminating the cap, and do not let the tip of the eye drop bottle touch any surface.

Does congenital dacryocystocele require hospitalization?

Hospitalization is usually unnecessary, as even surgical procedures can often be performed on an outpatient basis.

Can congenital dacryocystocele be completely cured?

Yes, it can be fully cured.

DIET & LIFESTYLE

How to Care for a Baby with Congenital Dacryocystocele?

• Both the baby and family members should wash hands and trim nails frequently to prevent infection.
• The baby may experience frequent tearing. Use clean tissues, sterilized cotton swabs, or gauze to wipe the area to avoid infection.
• If the baby resists eye drops, administer them while the baby is asleep or just waking up.

PREVENTION

Can congenital dacryocystocele be prevented?

There is no effective prevention method.