A Case of Bilateral Congenital Dacryocystocele Infected with Serratia marcescens

Congenital nasolacrimal duct obstruction (CNLDO) is a common disorder that affects approximately 6-20% of children in the first year of their life. Here we present a case of bilateral congenital dacryocystoceles infected with Serracia marcescens. A 50 day old male infant, born by caesarean section at term, presented to the clinic with a swelling and hyperemia on the region of the left lacrimal sac for 3 days, with a purulent discharge coming from both eyes. He had bilateral probing, irrigation and nasolacrimal tube silicone intubation under general anesthesia. During this procedure a heavy pus kept on coming from both canals and the ruptured area. This material was cultured in blood, MacConkey, and chocolate agar. S.marcescens was isolated which was shown to be susceptible to piperacillin, tazobactam, ceftazidim, cefepim, aztreonam, imipenem, meropenem, amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, tigecycline, trimethoprim-sulfamethoxazole; but resistant to netilmycin and colistin. The symptoms resolved in a week and the antibiotics were stopped. Conservative approach including gentle massage and warm compresses with topical antibiotics are recommended in the management of congenital dacryocystocoeles. If it progresses to acute dacryocystitis,  intravenous antibiotics are indicated to prevent fatal complications like meningitis, brain abscess and sepsis. In case of failure of probing, extensive marsupialization of the cyst, silicone tube implantation or balloon dacryocystoplasty is recommended.