Lacrimal Abscess in the Newborn: A Report of Seven Cases

ALTHOUGH the treatment of congenital dacryostenosis has led to controversy for many years, its main complication, acute dacryocystitis with formation of lacrimal abscess, has received little attention.Abscess formation in congenital dacryostenosis is rare, but is probably not as infrequent as reports in the literature suggest.Some cases of con- genital lacrimal fistula are probably inflammatory in origin (Duke-Elder, 1952) and many cases of chronic dacryocystitis in children requiring surgical intervention probably originate from unsuccessful treatment of recurrent lacrimal abscess in infancy (Zentmayer, 1937;MacGillivray, 1939).Mayou (1908) reported eight cases of lacrimal abscess in the newborn, and since that time isolated cases have been reported by Holdsworth (1913), Riser (1935), Town (1943), Cassady (1948), Redmond (1949), Koke (1950), Blankstein (1952), and Hurd (1955).During the past 5 years, 440 cases of congenital dacryostenosis have been treated at the Children's Hospital, Sheffield.Seven of these patients presented with acute dacryocystitis with abscess formation.Lacrimal abscess in the newborn does not arise de novo.There is always evidence of congenital dacryostenosis before the occurrence of acute inflam- mation of the lacrimal sac.There may be either discharge or epiphora occurring shortly after birth, or an encysted mucocoele may be present at birth.Symptoms of acute inflammation usually occur within one month of birth, but cases of later onset have been reported (2 months, Riser, 1935; 4 months, Koke, 1950).In the present series, acute symptoms occurred within one-month of birth in all cases, and the infecting organism, where known, was S. pyogenes.Case Reports Case 1, a boy aged one month, was first seen on July 12, 1955, with a left lacrimal abscess.A chronic discharge from his left eye had been noticed 4 days after birth.On July 9 his mother observed a swelling at the inner corner of the left eye which had become red and inflamed.