Dacryoendoscopic Findings of Lacrimal Passage with Congenital Punctal Atresia

Abstract

A 43-year-old woman presented with epiphora caused by upper and lower congenital punctual atresia with papilla. She underwent 2-snip punctoplasty and intubation under local anaesthesia. During the surgery, a dacryoendoscopic examination was performed. After performing the punctoplasty, the lacrimal passage was confirmed to have complete canalisation to the nasal cavity. Both upper and lower canaliculi appeared to be narrower and had difficult expansion compared with canaliculi in congenital nasolacrimal duct obstruction or primary acquired nasolacrimal duct obstruction without canalicular stenosis. The lacrimal sac and the nasolacrimal duct also showed complete canalization with normal colour.

Congenital Nasolacrimal Duct Obstruction

“…Therefore development of the lacrimal sac and nasolacrimal duct occurs earlier than the canaliculi, but the caudal end of the nasolacrimal duct is the last to canalize [ 7 ]. This explains why pathology in CNLDO is mostly present at the distal end, where the NLD normally opens into the inferior meatus ( Fig.…”

“…At the 7th month, the puncta opens when the two eyelids start to separate. At the caudal end where the lacrimal cord and inferior meatal lamina are present, apoptosis of cells to form a luminal passage occurs but varies from 6 months intrauterine to several weeks or months after birth [ 7 ].…”

Congenital nasolacrimal duct obstruction with fungal dacryoliths

“…This is similar to dacryoliths in adults, where lacrimal endoscopy has been useful for a direct inspection of the nasolacrimal passage. 8,9 We must be aware that CNLDO with dacryoliths can exist if the symptoms remain despite a successful probing. Some cases of CNLDO with dacryoliths may go unrecognized if lacrimal endoscopy is not used; thus, the incidence of this condition may be underreported.…”