Dacryocystoceles are caused by obstruction of both the proximal and distal ends of the nasolacrimal duct. An imperforate Hasner valve causes the distal blockage, but the cause of proximal obstruction is less clearly understood but the Rosenmuller valve has been implicated.
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Epidemiology
Dacryocystoceles, although rare, are the second most common cause of neonatal nasal obstruction after choanal atresia and require prompt treatment. Dacryocystoceles may be unilateral (75%) or bilateral (25%) and have no sex predilection. Secondary dacryocystitis may develop 5.
Clinical presentation
They commonly manifest as a tense, blue-gray mass at the medial canthus or in the nasal cavity. Dacryocystoceles can cause:
- nasal obstruction
- become infected (postnatal infection of an intact dacryocystocele is known as dacryocystitis)
- spontaneously rupture so that their contents drain into the nose
Radiographic features
Ultrasound
- confirms cystic and not solid mass 5
CT
CT is the imaging modality of choice and allows identification of a dacryocystocele and differentiation from other intranasal masses. CT features include:
- nasolacrimal duct dilatation
- homogeneous, well-defined, thin-walled mass with fluid attenuation involving the medial canthus or nasal cavity
- superior displacement of the inferior turbinate bone and contralateral shift of the nasal septum
Intravenous administration of contrast material may demonstrate slight enhancement of the cyst wall that is more pronounced in dacryocystitis. Adjacent soft-tissue enhancement and swelling are also common in dacryocystitis.
Treatment and prognosis
Treatment of dacryocystoceles is graded and ranges from manual pressure to probing with irrigation to endoscopic resection and marsupialization in severe cases.
Differential diagnosis
Possible differential considerations include 5:
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