L.J. Eye Institute, Ambala, India.
Govindram Seksaria Institute of Dacryology, L.V. Prasad Eye Institute, Hyderabad, India.
Ophthalmic Plast Reconstr Surg. 2019 Jul/Aug;35(4):309-317. doi: 10.1097/IOP.0000000000001297.
To provide a systematic review of the literature on congenital dacryocystoceles (CDCs) and summarize their presentations, investigations, management, and outcomes.
The authors performed a PubMed search of all articles published in English on CDCs. Data captured include demographics, clinical presentations, investigations, management modalities, complications, and outcomes. Fourteen major series (10 or more than 10 cases) and 89 isolated case reports/series on CDCs with a collective patient pool of 1,063 were studied in detail. Specific emphasis was laid on addressing the controversial issues including initial conservative versus surgical management and the role of endoscopic evaluation.
Numerous terminologies have been used to describe CDC. Congenital dacryocystoceles are rare variants of congenital nasolacrimal duct obstructions and comprise of 0.1% to 0.3% of all such cases. There is a female predilection (64.2%, 683/1,063) and the mean age at presentation is at 7 days of birth. Initial conservative treatment can be a viable option in the absence of an acute dacryocystitis or a respiratory distress. Endoscopy-assisted probing appears to have better outcomes as compared with the in-office probing. Congenital dacryocystoceles with acute dacryocystitis are preferably managed with intravenous antibiotics and an early probing under endoscopy guidance to avoid missing intranasal cysts. Marsupialization is the preferred technique in the management of intranasal cysts. Silicone intubation was rarely used and has no definitive indications. Dacryocystorhinostomy is very rarely needed in the management of CDC.
Congenital dacryocystocele is a commonly accepted term and its use should be advocated to enhance uniformity in reporting. Endoscopic evaluation of CDC is useful in the diagnosis and treatment of associated intranasal cysts and enhances the rates of successful outcomes.
对先天性泪囊囊肿（CDCs）的文献进行系统回顾，总结其临床表现、检查、治疗和结局。
作者对所有以英文发表的关于 CDC 的文献进行了 PubMed 检索。所获取的数据包括人口统计学资料、临床表现、检查、治疗方式、并发症和结局。详细研究了 14 个主要系列（10 个或 10 个以上病例）和 89 个孤立的 CDC 病例报告/系列，共有 1063 例患者。特别强调解决了一些有争议的问题，包括初始保守治疗与手术治疗的选择以及内镜评估的作用。
已经使用了许多术语来描述 CDC。先天性泪囊囊肿是先天性鼻泪管阻塞的罕见变异，占所有此类病例的 0.1%至 0.3%。女性发病率较高（64.2%，683/1063），平均发病年龄为出生后 7 天。在没有急性泪囊炎或呼吸窘迫的情况下，初始保守治疗可能是一种可行的选择。与门诊探通术相比，内镜辅助探通术的效果似乎更好。伴有急性泪囊炎的先天性泪囊囊肿最好采用静脉抗生素治疗，并在早期进行内镜引导下的探通术，以避免漏诊鼻内囊肿。造袋术是治疗鼻内囊肿的首选技术。硅胶插管很少使用，也没有明确的适应证。在 CDC 的治疗中很少需要行泪囊鼻腔吻合术。
先天性泪囊囊肿是一个被广泛接受的术语，应该提倡使用，以提高报告的一致性。CDC 的内镜评估有助于诊断和治疗相关的鼻内囊肿，并提高治疗成功率。
