Massive Orbital Extension of a Congenital Dacryocystocele in a 9 Month Old
Carrere, Jonathan; Lewis, KyleRead More
A 9-month-old male presented with gradual right medial canthus swelling since age 3 months. On examination, there was a medial cystic orbital mass causing significant telecanthus and lateral displacement of the right globe (Fig. A). There was limited adduction of the right eye and exotropia. The patient was able to fix and follow a penlight. The pupils were briskly reactive in both eyes, and there was no relative afferent pupillary defect. The anterior and fundus examinations were normal in both eyes. Endonasal exam was unremarkable. An axial and coronal computed tomography scan (Fig. B,C) showed a large (3.7 × 2.3 × 3.5 cm) medial cystic lesion arising from the lacrimal system. There were no bony defects or encephalocele noted. The patient underwent nasolacrimal duct probing, which was unsuccessful as the probe was unable to pass into the nasolacrimal duct. Dacryocystorhinostomy resulted in decompression of the dacryocystocele and return of normal eye position.
Congenital dacryocystocele is seen in the setting of nasolacrimal duct obstruction in the neonatal period. As in this case, goblet cells lining the lacrimal sac can continuously secrete mucous and cause dacryocystocele enlargement over time. Complications include infection, intranasal extension, airway obstruction (if bilateral), and rarely intraorbital extension. Massive orbital extension of a dacryocystocele can mimic other orbital masses, including encephalocele, dermoid cyst, or neoplasms, and may require adjunctive imaging for diagnosis.