SPECTRUM OF PEDIATRIC DACRYOCYSTITIS - MEDICAL AND SURGICAL-MANAGEMENT OF 54 CASES

Background: Dacryocystitis in infants and older children is a serious complication of congenital or acquired nasolacrimal duct obstruction. To define the modes of presentation and treatment strategies of this d isorder better, we reviewed the clinical courses of 54 children treate d for dacryocystitis at St Louis Children's Hospital. Methods: Clinica l, neuroradiologic, and laboratory data were collated for all cases of dacryocystitis treated from 1990 to 1995. Average follow up of the ch ildren in this consecutive series was 1.75 years (range, 4 months to 5 years).Results: Of the 54 patients, 36 (67%) had chronic low-grade da cryocystitis, which was treated with nasolacrimal duct probing on an o utpatient basis. The remaining 18 patients (33%) had acute dacryocysti tis, which was treated with a combined medical/surgical strategy. Medi cal treatment consisted of hospital admission for administration of in travenous antibiotics followed by inpatient surgery, which varied acco rding to the age of the patient and the clinical history: 1) Acute dac ryocystitis in neonates was treated surgically by nasolacrimal duct pr obing and nasal endoscopy for excision of intranasal duct cyst; 2) Acu te dacryocystitis with periorbital cellulitis was treated surgically b y nasolacrimal duct probing; 3) Acute dacryocystitis due to facial tra uma was treated surgically by dacryocystorhinostomy and stent placemen t; and 4) Acute dacryocystitis complicated by orbital abscess was trea ted by inferior orbitotomy for orbital abscess drainage, simultaneous nasolacrimal duct probing, and stent placement. Conclusion: Dacryocyst itis in the pediatric population may present in either chronic or acut e forms. An effective and safe treatment for acute dacryocystitis is h ospital admission, both for administering intravenous antibiotics and monitoring to rule out orbital cellulitis or abscess formation. Intrav enous antibiotic therapy is followed within a day or two by surgery ta ilored to the clinical history. In the majority of both chronic and ac ute cases, nasolacrimal duct probing appears to be an effective treatm ent strategy.