Urgent bilateral endoscopic marsupialization for respiratory distress due to bilateral dacryocystitis in a newborn

Abstract

We describe an infant with respiratory distress due to bilateral dacryocystoceles and dacryocystitis who was successfully treated with urgent bilateral endoscopic marsupialization. A male infant was brought to our outpatient department 7 days after birth, with red, acutely inflamed swellings near the medial canthal area of both eyes. From birth, there had been bluish swelling near the medial canthal area, and redness and swellings developed within 3 days. On physical examination, the child was afebrile but showed respiratory distress with coarse breathing sound. That day, the infant was admitted and treated with intravenous cefotaxime 150 mg. After withholding oral intake for appropriate preoperative fasting, urgent bilateral probing with endoscopy was done. On endoscopy, huge bilateral congenital dacryocystoceles were found. Because of its huge size, the inferior surface of the cyst was touching the nasal floor, which made probe unable to perforate the wall of dacryocystocele. Therefore, an endoscopy-assisted marsupialization of dacryocystoceles and bicanalicular silicone intubation were performed. Both swellings and erythema subsided within 48 hours postoperatively, and the patient was discharged after 72 hours from treatment.

FIGURE 1

A, Photograph of an infant with a red, acutely inflamed swelling near the medial canthal area of both eyes before the surgery. B, Photograph of 1 day after the operation. C, Photograph of 2 days after the operation.

FIGURE 2

Endoscopic view of right dacryocystocele (A) and left dacryocystocele (B) before the surgery. Endoscopic view of right (C) and left (D) marsupialized dacryocystoceles.