Computed tomography for guidance in the diagnosis and surgical correction of recurrent pediatric acute dacryocystitis

Abstract

Importance This is the first retrospective study of the effect of computed tomography (CT) in diagnosis and surgical correction of recurrent pediatric acute dacryocystitis (PAD). Objective To explore the pathogenesis of recurrent PAD and the impact of CT in guidance of surgical planning. Methods Medical histories, clinical manifestations, and CT results of 10 patients with recurrent PAD were reviewed. Etiologies and treatment effectiveness were recorded for all patients. Results CT revealed that three patients had congenital dacryocystocele with lacrimal sac cyst, enlargement of the nasolacrimal canal, and intranasal cyst of affected sides. After regression of local inflammation, marsupialization was performed. CT showed that four patients had PAD secondary to congenital nasolacrimal canal dysplasia; these patients exhibited normal upper portions of the nasolacrimal canals, but had stenotic or atretic middle and terminal segments. After improvement of local inflammation, endonasal dacryocystorhinostomy was performed. Three patients had PAD secondary to congenital lacrimal sac diverticulum; after contrast injection, CT showed that the cysts at the lacrimal sac area were filled with contrast, and were connected to the normal lacrimal sac. After the topical infection was controlled, transcutaneous dacryocystorhinostomy was performed in combination with excision of the lacrimal sac diverticulum. No recurrence of PAD was detected at 6‐month follow‐up. Interpretation Causes of PAD include congenital dacryocystocele, congenital lacrimal sac diverticulum, or congenital nasolacrimal canal dysplasia. Marsupialization with endoscope, endonasal dacryocystorhinostomy, and transcutaneous dacryocystorhinostomy constitute distinct surgeries for PAD treatment. CT provides an important diagnostic function and facilitates selection of specific surgical approaches for recurrent PAD.

A case report of proboscis lateralis: emphasis on the reconstruction of the lacrimal drainage system

“…This suggests the need for adequate ophthalmic evaluations while screening for congenital deformities in patients with PL. CT scans play a crucial role in the diagnosis of congenital nasolacrimal canal dysplasia because it can exactly delineate the shape, direction, and abnormal structure of the bony nasolacrimal duct ( 10 ). Subsidiary MRI and ultrasound exams provided information for planning appropriate management about the mass and assessed the exact location and dimensions of the lacrimal drainage system.…”

The epidemiology and the pathogen distribution of pediatric dacryocystitis in Chinese population 2017–2022

“…Congenital dacryocyst is a cyan cystic mass in the inner canthus of newborns, and is caused by obstruction at both ends of the diversion channel [ 6 ]. Some study reported that in children, nearly 60% of patients with congenital dacryocyst eventually develop a peri-dacryocyst infection [ 7 , 8 ]. Dacryocystitis is mainly caused by Gram-positive cocci, especially Streptococcus pneumoniae ; due to the misuse of anti-Gram-positive cocci antibiotics, Gram-negative Enterobacteriaceae have risen in the proportion of dacryocystitis pathogens [ 9 ].…”