Acute dacryocystitis in pediatric patients and frequency of nasolacrimal duct patency

Purpose: To study acute dacryocystitis in a pediatric age group, focusing on patients' demographic profiles, clinical presentation, and management outcome. Methods: A retrospective case series of all acute dacryocystitis in pediatric patients (0-17 years) from two tertiary-care eye centres in Riyadh, Saudi Arabia was conducted. Demographic profile, risk factors, initial clinical presentation, management regimens, and final outcome were analysed. Results: A total of 51 patients were included in the study. The mean age of presentation was 3.9 +/- 4 years (1 month-13 years). Thirty-eight patients (74.5%) reported symptoms of congenital nasolacrimal duct obstruction (NLDO) prior to presentation, four patients (7.8%) had congenital dacryocystocele, two (3.9%) had a history of traumatic NLDO, and ten (19.6%) had an attack of acute dacryocystitis in the absence of NLDO or any other known risk factors. Four patients (7.8%) progressed to orbital cellulitis while another three (5.8%) had lacrimal sac fistula secondary to acute dacryocystitis. Systemic antibiotics were the initial management in all 51 patients. Twenty-five (49%) underwent probing after the resolution of the acute attack while 12 (23.5%) patients underwent dacryocystorhinostomy (DCR). Conclusions: Early recognition and urgent management for acute dacryocystitis are required to prevent further potential complications and achieve excellent outcomes. Congenital NLDO is the main risk factor for the development of acute dacryocystitis in the pediatric age group. In a small set of patients, acute dacryocystitis can develop despite the presence of a patent lacrimal drainage system on clinical evaluation with lack of tearing and discharge before and after the attack of acute dacryocystitis.