Heichel J, Struck H-G, Hammer T, Viestenz A, Plontke S, Glien A
Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
Universitätsklinik und Poliklinik für Hals‑, Nasen‑, Ohrenheilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
HNO. 2019 Jun;67(6):458-462. doi: 10.1007/s00106-019-0671-1.
Pediatric acute dacryocystitis typically develops due to persistence of Hasner's membrane. Pediatric paranasal mucoceles are rare entities. In contrast, chronic dacryocystitis in cases of congenital dacryostenosis is one of the most frequent pediatric ophthalmologic issues.
The case report of a 10-year-old girl suffering acute dacryocystitis is presented.
The area around the left lacrimal sac showed a painful swelling with edema and hyperemia. Systemic and local antibiotic therapy resulted in only slight improvement. Dacryoendoscopy detected acute dacryocystitis with significant stenosis of the nasolacrimal duct. The nasolacrimal duct was widened dacryoendoscopically and autostable bicanalicular nasolacrimal intubation was performed. Nevertheless, the lacrimal ducts were blocked subtotally and a widening of the ethmoid on the left side was shown by rhinoscopy. Magnetic resonance imaging confirmed a frontoethmoidal mucocele which was treated by marsupialization. During the 24-month follow-up there was no recurrence of acute dacryocystitis. There were no signs of sinusitis.
Paranasal mucoceles, e. g., ethmoidal mucoceles, can compress the lacrimal pathways and cause acute lacrimal inflammation in childhood. Paranasal mucoceles should thus be excluded in cases of unclear masses in the lacrimal region.
小儿急性泪囊炎通常是由于哈氏膜持续存在所致。小儿鼻旁窦黏液囊肿较为罕见。相比之下，先天性泪道狭窄病例中的慢性泪囊炎是最常见的小儿眼科问题之一。
本文报告了一名10岁患急性泪囊炎女孩的病例。
左侧泪囊周围区域出现疼痛性肿胀，伴有水肿和充血。全身及局部抗生素治疗仅略有改善。泪道内镜检查发现急性泪囊炎伴鼻泪管明显狭窄。通过泪道内镜扩张鼻泪管并进行了自稳定双泪小管鼻泪管插管。然而，泪道仍部分阻塞，鼻内镜检查显示左侧筛窦增宽。磁共振成像证实为额筛窦黏液囊肿，采用袋形缝合术治疗。在24个月的随访中，急性泪囊炎未复发。无鼻窦炎迹象。
鼻旁窦黏液囊肿，如筛窦黏液囊肿，可压迫泪道并在儿童期引起急性泪囊炎。因此，在泪区肿物情况不明时应排除鼻旁窦黏液囊肿。
