RESUMO
PURPOSE: To determine the proper management of congenital dacryocystocele. DESIGN: Retrospective interventional case series. SETTINGS: Clinical practice. STUDY POPULATION: Twenty-seven consecutive patients with 29 congenital dacryocystoceles who presented from 1987 through 2006. MAIN OUTCOME MEASURES: The charts were reviewed for the presence and age of onset of infection, methods and age of treatment, and response to treatment. RESULTS: Dacryocystitis and preseptal cellulitis requiring intravenous antibiotic therapy were present in 11 lacrimal systems (37.9%), and dacryocystitis without cellulitis was present in an additional 10 lacrimal systems (34.5%). One or more probings were performed in 26 patients (89.7%). Resolution with conservative therapy occurred in three lacrimal systems. The initial probing was successful in seven of seven lacrimal systems (100%) that did not have infection, but was successful in only 10 of 19 lacrimal systems (53%) that had dacryocystitis with or without cellulitis. The mean age of probing in the surgical patients who did not develop infection was 5.9 days, whereas the mean age at first probing in surgical patients who developed infection was 17.3 days. CONCLUSIONS: Patients with congenital dacryocystocele should have probing on an urgent basis and as early in life as possible, unless the lacrimal sac decompresses into the nose at the time of the initial examination. This approach will reduce the incidence of dacryocystitis and cellulitis, and improve the success rate of surgery.
Assuntos
Dacriocistorinostomia/métodos , Obstrução dos Ductos Lacrimais/congênito , Ducto Nasolacrimal/anormalidades , Ducto Nasolacrimal/cirurgia , Idade de Início , Antibacterianos/uso terapêutico , Celulite (Flegmão)/congênito , Celulite (Flegmão)/cirurgia , Dacriocistite/congênito , Dacriocistite/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
We describe a girl with eosinophilic cellulitis (Wells syndrome) in whom the disease appeared immediately after birth with subcutaneous nodules on the scalp and trunk, followed by the characteristic skin swelling and erythema at the age of 6 months. The lesions disappeared after a few weeks, but recurred several times. The mother had consumed large quantities of medications during the pregnancy, including iron, vitamins, and "natural remedies." Based on time of onset, this may be regarded as a unique case of congenital Wells syndrome. Its relation to the medications taken by the mother remains speculative. Subcutaneous nodules may be the presenting sign of Wells syndrome in children.