Stepwise treatment paradigm for congenital nasolacrimal duct obstruction.

PURPOSE: To compare the outcomes achieved by a series of patients treated in a stepwise fashion who presented with congenital nasolacrimal duct obstruction. METHODS: In this retrospective interventional case series, 127 patients, ranging in age from 1 month to 81 months, with 173 lacrimal systems diagnosed with congenital nasolacrimal duct obstruction, were treated in a stepwise fashion. A treatment paradigm was evaluated that prescribed probing as an initial procedure regardless of age. Those who failed probing received balloon catheter dilation. Those who failed probing and balloon catheterization received silicone intubation. Dacryocystorhinostomy was reserved for patients failing the above treatments. Clinical success was defined as complete resolution of symptoms. Success rates at each step were evaluated, and a cost analysis was performed. RESULTS: Lacrimal probing was successful in 134 of 173 (76.9%) cases. Of the 39 probing failures, 32 (82.1%) were cured with balloon catheterization. All 7 cases (100%) that failed probing and balloon catheterization were cured with silicone intubation. No patient in this series required dacryocystorhinostomy. CONCLUSIONS: A stepwise approach to the treatment of congenital nasolacrimal duct obstruction is a clinically and financially effective model for treatment.

Eyelid abscess as a presenting sign of occult sinusitis.

PURPOSE: To describe 5 patients who presented with eyelid abscesses whose subsequent workup revealed occult sinusitis. METHODS: We reviewed the medical records of 5 patients who presented with eyelid abscess. Common presenting signs and symptoms were identified. Successful diagnosis and treatment was accomplished in each case. RESULTS: All patients were in good general health and did not appear to be systemically ill. Eyelid swelling was the chief presenting complaint of each patient. None of the patients complained of fevers or chills. Each patient had an upper eyelid abscess. Symptoms suggestive of sinusitis included purulent nasal discharge and headache. With appropriate radiologic studies, extensive occult sinusitis was identified in each case. Two patients demonstrated a small defect in the bone between the infected frontal sinus and the eyelid. All patients received intravenous antibiotics followed by oral antibiotics, incision and drainage of the abscess, and, after ENT consultation, functional endoscopic sinus surgery. All patients improved after treatment, and none had permanent visual loss. CONCLUSIONS: Clinical suspicion of sinusitis may be aroused with a thorough history and examination. Radiographic evaluation and prompt treatment of both the eyelid abscess and the sinusitis can result in good outcomes for such patients.

Unusual complex choristoma of the lateral canthus.

This report details the gross and histopathologic findings of an unusual complex choristoma at the lateral canthus. Although this lesion displays elements of hair follicle nevus, bulbar dermoid, epibulbar osseous choristoma, and accessory tragus, it does not fit neatly in any of these categories. We propose that this lesion is the result of faulty migration of pluripotential cells during embryogenesis.