Unusual Anatomy of the Nasolacrimal Duct

Tuesday, April 25, 2017
By Duke Health I Catherine Lewis

This case originally appeared on April 25, 2017 in Clinical Practice Today 

A 3-month-old infant was referred to a local pediatric ophthalmologist for constant tearing and mattering of her lashes, with recurrent infections of the nasolacrimal sac that required an episode of intravenous antibiotics. Following unsuccessful surgery to open the tear-drainage system, the patient was referred for further evaluation and care to Duke pediatric ophthalmologist Laura Enyedi, MD.

Enyedi observed that the patient had bilateral dacryocystoceles with a risk of intranasal cysts that often occur in conjunction with dacryocystocele, so she scheduled a joint surgical procedure with pediatric otolaryngologist Eileen Raynor, MD, to perform simultaneous nasolacrimal duct probing with nasal endoscopy and removal of the nasal cyst.

During the procedure, Enyedi and Raynor encountered an unusual, dense, bony blockage of the nasolacrimal system. Computed tomography confirmed that the infant’s nasolacrimal ducts “dead-ended” into the maxilla, leading to a backup of fluid that provided the ideal environment for infection.

Question: What procedure did Raynor and Enyedi perform to clear the obstruction?

Read the Case Conclusion