Sir,

Congenital dacryocystocele is a benign solitary mass arising from narrowing or obstruction of the nasolacrimal system during natal development. Its prenatal diagnosis, using sonography, is straightforward. CT and MRI are of benefit only if the diagnosis is unclear.1 It is usually detected during the third trimester. Many lesions resolve spontaneously or after minimal intervention.

Case report

We report a case of a healthy male neonate with a congenital dacryocystocele, which was diagnosed pre-natally. The mother was a 30-year-old primigravida with no history of consanguinity. A routine screening ultrasound test at 20 weeks of gestation was normal. At 33 weeks' gestation, she underwent a second routine ultrasound scan. Both surveys were performed using an ATL 3000 ultrasound machine (Philips Medical Systems, Bothell, WA, USA). At this second examination, a unilateral 10 mm hypoechogenic mass was located inferiomedially to the right orbit. The differential diagnosis for a medial canthal mass includes dacryocystocele, capillary hemangioma, solid dermoid, dermoid cyst, encephalocele, meningoencephalocele, nasal glioma, lymphangioma, and heterotopic brain. Further examination did not reveal any other pathological findings and demonstrated normal fetal facial anatomy (Figure 1). Repeated scans demonstrated no change in the mass size. On the 39th week of gestation, a vacuum extraction delivery was performed. Gestational weight was 2105 g. His Apgar score was 9/10. The diagnosis of congenital dacryocystocele was confirmed postnatally (Figure 2a). The infant had no signs of epiphora, dacryocystitis, facial cellulitis, or airway obstruction. The lesion resolved spontaneously 24 h postnatally with no further intervention (Figure 2b).

Figure 1
figure 1

Prenatal ultrasound scan (at 33 weeks' gestation) that demonstrates the globe, the dacryocystocele (arrow), and the nose.

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Figure 2
figure 2

Postnatal photograph (a) immediately after birth showing the dacryocystocele; a bluish, cystic, non-tender, firm mass inferior to the right medial canthal tendon and (b) spontaneous resolution of the dacryocystocele 24 h later with no further intervention.

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Comment

Prenatal diagnosis of dacryocystocele is very important because of the possibility of accompanying pathologies such as anterior encephalocele, teratoma, hemangioma, glioma, or rhabdomysarcoma.2 A retrospective study of congenital dacryocystoceles showed complete resolution in 90% of cases following surgery, favouring early surgical intervention.3 Another retrospective study reported spontaneous resolution in 16.7% with a recurrence rate of 22% after probing.4 We suggest conservative treatment initially. If spontaneous resolution does not occur within 24 h, then the nasolacrimal probing is the treatment of choice. Surgical intervention may benefit those who are suffering from dacryocystitis, facial cellulitis, breathing difficulty, recurrences, and failure of digital massage, or probing.