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Lacrimal Anomalies
Leonard B. Nelson and Harold P. Koller 
CONGENITAL MUCOCELE
When an obstruction at the upper and lower portions of the lacrimal system occurs, fluid accumulates and causes a distention of the lacrimal sac at birth, termed a mucocele.
Etiology
Sporadic
Concomitant blockage at the valve of Rosenmüller and in the nasolacrimal duct leads to the formation of lacrimal sac mucoceles.
Symptoms
Tearing
Difficulty breathing
Difficulty with breastfeeding on the mother’s breast ipsilateral to the mucocele
Signs
Blue-gray swelling inferior to the medial canthal tendon at birth (Fig. 8-1).
Secondary infection (erythema of the tissues overlying the lacrimal sac) may occur.
Mucocele may extend intranasally as a submucocele mass along the nasal floor beneath the inferior turbinate.
Differential Diagnosis
Hemangioma
Dermoid
Encephalocele
Nasal glioma
Treatment
Conservative management includes gentle massage and warm compresses.
Dacryocystitis can develop within a few days or weeks and requires systemic antibiotics.
Ultimately, if the mucocele cannot be decompressed with massage, within several days, prompt probing has been recommended. Rarely, serious complications of central nervous system infections have been reported; therefore, some have recommended early probing.
Prognosis
The resolution rate with conservative management is approximately 76%.
If probing is necessary, resolution can be accomplished.
REFERENCES
Harris GJ, DiClementi D. Congenital dacryocystocele. Arch Ophthalmol. 1982;100:1763–1765.
Schnall BM, Christain CJ. Conservative treatment of congenial dacryocele. J Pediatr Ophthal Strabismus. 1996;33:219–222.
Wong RK, VanderVeen DK. Presentation and management of congenital dacryocystocele. Pediatrics. 2008;122:1108–1112.
Figure 8-1. A. Mucocele of the nasolacrimal system showing swelling and mild erythema. B. Mucocele showing more significant swelling and erythema. C. Bilateral mucoceles.
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