| 본문 : Purpose
To report a case of bilateral dacryocystocele occurred just a gap of time which had been misdiagnosed initially as a sac-origin tumor or dacryocystitis accompanying nasolacrimal duct obstruction (NLDO), treated with stepwise endonasal endoscopic dacryocystorhinostomy (endoDCR).
Case Report
40 year-old female came to our hospital complaining a palpable mass around the right medial canthus and bilateral epiphora. She had been treated her painful periocular swelling in another local clinic with oral antibiotics but the palpable mass persisted. At ocular examination, this non-tender, immobile mass was located under the medial canthal tendon and CT scan showed well demarcated low density mass at the right lacrimal fossa. Lacrimal syringing test and probing demonstrated blockage at the level of the nasolacrimal dust in both side and the mass became harder with infusion. Applying pressure to mass did not led to reflux of material through the puncta. To rule out the sac origin tumor or dermoid, surgical exploration with external approach was performed and the enlargement of lacrimal sac was identified. Under the diagnosis of dacryocystocele, endoDCR and silicone tube insertion was performed on her right eye. Lacrimal sac mucosa was inflamed and the sac was filled with purulent discharge which was positive for coagulase negative staphylococcus aureus. With topical and oral antibiotics, her symptom got improved gradually thereafter. 2 months after the DCR on right eye, the patient complained periocular swelling with palpable, tender mass below the level of the left medial canthal tendon that is practically the same of the periocular signs of her right side. Under the diagnosis of dacryocystocele accompanied with acute dacryocystitis, endoDCR was performed on her left side. The patient remained free of epiphora and had no recurrence sac mass throughout the 13 months follow-up period.
Conclusions
Dacryocystocele can be easily misdiagnosed as sac origin tumor, dermoid cyst or dacryocystitis with NLDO unless thorough suspicion. Dacryocystoceles can occur just a gap of time bilaterally in an adult because of similar anatomical features such as functional proximal obstruction at Rosenmuller’s valve and NLDO.
|