Abstract
RATIONALE: Acquired dacryocystocele is a rare condition in adults and is often associated with distal and proximal lacrimal drainage obstructions. While proximal obstruction has generally been presumed to be functional, this assumption has not been definitively confirmed in previous studies. In this case series, we report for the first time the use of direct dacryoendoscopic probing as both a diagnostic and therapeutic adjunct to endonasal dacryocystorhinostomy (DCR) in the management of acquired dacryocystocele. PATIENT CONCERNS: Three patients (1 male and 2 females; age, 66-88 years) presented with unilateral epiphora and medial canthal swelling. Symptom duration ranged from 2 weeks to 2 years. One patient exhibited bluish discoloration over the medial canthus; another had a history of nasal surgery and concomitant frontal sinus mucocele with sinusitis. DIAGNOSES: All patients were diagnosed with acquired dacryocystocele based on clinical examination and imaging. Dacryoendoscopy confirmed complete mechanical common canalicular obstruction in each case. INTERVENTIONS: Each patient underwent endonasal DCR combined with intraoperative direct dacryoendoscopic probing to relieve the canalicular obstruction, followed by bicanalicular intubation. OUTCOMES: All patients achieved complete symptom resolution and demonstrated a widely patent rhinostomy on endoscopic follow-up at 6 months. No intraoperative or postoperative complications or recurrences were observed. LESSONS: This series suggests that mechanical common canalicular obstruction may be a key mechanism in the pathogenesis of acquired dacryocystocele. Incorporating direct dacryoendoscopic probing during DCR enables real-time identification and treatment of proximal obstruction, potentially improving surgical success and minimizing recurrence.