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Massive Orbital Extension of a Congenital Dacryocystocele in a 9 Month Old

Carrere, Jonathan, M.D.; Lewis, Kyle, M.D., Ph.D.

Ophthalmic Plastic & Reconstructive Surgery: January/February 2019 - Volume 35 - Issue 1 - p e25
doi: 10.1097/IOP.0000000000001175
OPRS Images

Department of Ophthalmology, University of Mississippi Medical Center, Jackson, Mississippi, U.S.A.

Accepted for publication June 1, 2018.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Jonathan Carrere, M.D., Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS. E-mail: jcarrere@umc.edu

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.

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