The presentation, clinical features, complications, and treatment of congenital dacryocystocele

Purpose To determine the incidence and presenting features of congenital dacryocystocele in the United Kingdom. To report on those cases complicated by dacryocystitis, respiratory compromise, and the treatment undertaken. Methods A prospective observational study of cases of congenital dacryocystocele presenting in the United Kingdom between September 2014 and October 2015. Infants <3 months of age presenting with a cystic swelling in the medial canthal area were included. Cases were identified via the British Ophthalmology Surveillance Unit (BOSU) reporting system. Results A total of 49 cases were reported during the study period. This gives an incidence of 1 in 18 597 live births. There was a 71% response rate to the questionnaire. The average age at presentation was 16.94 days. Dacryocystoceles were unilateral in 91% of cases. Dacryocystitis was a complicating factor in 49% of patients and 17% had respiratory distress. Uncomplicated dacryocystocele responded well to conservative measures in 86%. Surgical intervention was required in 23% of patients. Those cases complicated by dacryocystitis (29%) and nasal obstruction (17%) were more likely to require surgical intervention compared to those with dacryocystocele alone (14%). Digital massage appears to reduce the likelihood of requiring surgical intervention. The mean time to resolution was 19 days. Conclusions Congenital dacryocystocele is a rare presentation in the United Kingdom. Dacryocystitis and respiratory compromise commonly complicate a dacryocystocele. The use of digital massage as an early intervention is advocated and conservative measures may be sufficient in cases of uncomplicated dacryocystocele

Evolving Perspectives on Congenital Glaucoma

Congenital glaucoma differs from adult glaucoma in that it represents a panocular disorder defined by structural, functional, and physiologic parameters. In order to achieve excellent visual outcomes, the management of congenital glaucoma involves concurrently controlling intraocular pressure and treating amblyopia, while minimizing any influence of a compromised visual axis. Thus far, difficulty in assessing visual function in pre-verbal children has resulted in a paucity of long-term visual outcome data. However, based on commonly recognized obstacles to structural/physiologic stability and functional rehabilitation status, we propose a congenital glaucoma severity scale in order to provide a cross-sectional stratification of disease severity. As the severity of pathology evolves over time, the severity score should be adjusted accordingly. The initial score and rate of changes in severity (“severity slope”) will help in prognosticating outcome. Future studies will be required to validate, calibrate, and discriminate this severity scale before clinical and research applications