CONGENITAL DACRYOCYSTITIS

It is an inflammation of the lacrimal sac occurring in
newborn infants; and thus also known as
dacryocystitis neonatorum.
Etiology
It follows stasis of secretions in the lacrimal sac due
to congenital blockage in the nasolacrimal duct. It
is of very common occurrence. As many as 30 percent
of newborn infants are believed to have closure of
nasolacrimal duct at birth; mostly due to ‘membranous
occlusion’ at its lower end, near the valve of Hasner.
Other causes of congenital NLD block are: presence
of epithelial debris, membranous occlusion at its
upper end near lacrimal sac, complete noncanalisation
and rarely bony occlusion. Common
bacteria associated with congenital dacryocystitis
are staphylococci, pneumococci and streptococci.
Clinical picture
Congenital dacryocystitis usually presents as a mild
grade chronic inflammation. It is characterised by:
1. Epiphora, usually developing after seven days
of birth. It is followed by copious mucopurulent
discharge from the eyes.
2. Regurgitation test is usually positive, i.e., when
pressure is applied over the lacrimal sac area,
purulent discharge regurgitates from the lower
punctum.
3. Swelling on the sac area may appear eventually.
Differential diagnosis
Congenital dacryocystitis needs to be differentiated
from other causes of watering in early childhood
especially ophthalmia neonatorum and congenital
glaucoma.
Complications
When not treated in time it may be complicated by
recurrent conjunctivitis, acute on chronic dacryocystitis,
lacrimal abscess and fistulae formation.
Treatment
It depends upon the age at which the child is brought.
The treatment modalities employed are as follows:
1. Massage over the lacrimal sac area and topical
antibiotics constitute the treatment of congenital
NLD block, up to 6-8 weeks of age. Massage
increases the hydrostatic pressure in the sac and
helps to open up the membranous occlusions. It
should be carried out at least 4 times a day to be
followed by instillation of antibiotic drops. This
conservative treatment cures obstruction in about
90 percent of the infants.
2. Lacrimal syringing (irrigation) with normal
saline and antibiotic solution. It should be added
to the conservative treatment if the condition is
not cured up to the age of 2 months. Lacrimal
irrigation helps to open the membranous occlusion
by exerting hydraulic pressure. Syringing may be
carried out once or twice a week.
3. Probing of NLD with Bowman’s probe. It should
be performed, in case the condition is not cured
by the age of 3-4 months. Some surgeons prefer
to wait till the age of 6 months. It is usually
performed under general anaesthesia. While
performing probing, care must be taken not to
injure the canaliculus. In most instances a single
probing will relieve the obstruction. In case of
failure, it may be repeated after an interval of 3-
4 weeks.
4. Intubations with silicone tube may be performed
if repeated probings are failure. The silicone tube
should be kept in the NLD for about six months.
5. Dacryocystorhinostomy (DCR) operations: When
the child is brought very late or repeated probing
is a failure, then conservative treatment by
massaging, topical antibiotics and intermittent
lacrimal syringing should be continued till the
age of 4 years. After this, DCR operation should
be performed.